A social media game to increase physical activity among older adult women: protocol of a randomized controlled trial to evaluate CHALLENGE.

BACKGROUND: Older adult women often do not engage in sufficient physical activity (PA) and can encounter biological changes that exacerbate the negative effects of inadequate activity. Wearable activity monitors can facilitate PA initiation, but evidence of sustained behavior change is lacking. Supplementing wearable technologies with intervention content that evokes enjoyment, interest, meaning, and personal values associated with PA may support long term adherence. In this paper, we present the protocol of an NIA-funded study designed to evaluate the efficacy of CHALLENGE for increasing step count and motivation for PA in insufficiently active older women (Challenges for Healthy Aging: Leveraging Limits for Engaging Networked Game-based Exercise). CHALLENGE uses social media to supplement wearable activity monitors with the autonomy-supportive frame of a game. We hypothesize that CHALLENGE will engender playful experiences that will improve motivation for exercise and lead to sustained increases in step count. METHODS: We will recruit 300 healthy, community dwelling older adult women on a rolling basis and randomize them to receive either the CHALLENGE intervention (experimental arm) or an activity monitor-only intervention (comparison arm). Participants in both groups will receive a wearable activity monitor and personalized weekly feedback emails. In the experimental group, participants will also be added to a private Facebook group, where study staff will post weekly challenges that are designed to elicit playful experiences while walking. Assessments at baseline and 6, 12, and 18 months will measure PA and motivation-related constructs. We will fit linear mixed-effects models to evaluate differences in step count and motivational constructs, and longitudinal mediation models to evaluate if interventional effects are mediated by changes in motivation. We will also conduct thematic content analysis of text and photos posted to Facebook and transcripts from individual interviews. DISCUSSION: By taking part in a year-long intervention centered on imbuing walking behaviors with playful and celebratory experiences, participating older adult women may internalize changes to their identity and relationship with PA that facilitate sustained behavior change. Study results will have implications for how we can harness powerful and increasingly ubiquitous technologies for health promotion to the vast and growing population of older adults in the U.S. and abroad. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT04095923. Registered September 17th, 2019.

Enhancing food access in a comprehensive cancer center area of influence through local partner capacity building.

BACKGROUND: Food insecurity, an economic and social condition of limited food access, is associated with poor diet quality-a risk factor for several common cancers. The University of Texas MD Anderson Cancer Center supports healthy food access through community-led evidence translation by actively partnering with community-based organizations (CBOs). These partnerships aim to enhance the capacity of food assistance CBOs to effectively implement evidence-based food insecurity mitigation programs in the cancer center's area of influence. METHODS: This case study aims to describe the cancer center's model for local food access capacity building and detail operationalization in the context of a whole-community cancer prevention effort (Be Well Baytown) in Baytown, Texas. RESULTS: Elements central to the capacity building model include (i) assessment of baseline needs and capacity, (ii) empowering a community champion within a relevant CBO, (iii) mapping inter-sectoral community partnerships, collaborations, and linkages, and (iv) leveraging systems, connections, and resources to provide an enabling environment for overall food access systems growth. Through this process, Be Well Baytown enhanced the capacity of a local food pantry leading to increases in total reach, pounds of food distributed, and number of food distribution events in collaboration with intersectoral partners from 2018 to 2023. CONCLUSION: This case study highlights the model's implementation as a co-benefit community partnership strategy to maximize the impact of food security programs integrated with comprehensive cancer center prevention efforts.

Outcomes for breast cancer survivors with metastatic disease in a physical activity program for medically underserved cancer survivors.

PURPOSE: This study examined the effectiveness and feasibility of the Active Living After Cancer (ALAC) program for metastatic breast cancer (MBC) survivors. METHODS: ALAC is a 12-session community-based program to help cancer survivors improve their physical functioning and quality of life through increased physical activity. ALAC participants with MBC (stage IV) were compared to survivors with early-stage breast cancer (stages I and II). The International Physical Activity Questionnaire, Godin Leisure-Time Physical Activity, 30-second sit-to-stand test, and PROMIS Global Health were administered at baseline and follow-up. Program satisfaction and retention were assessed at week 12. Repeated-measures mixed models were used to compare changes in outcomes between survivors with early-stage breast cancer and MBC. RESULTS: A total of 585 women (59.3 y ± 10.6), most of whom were Hispanic (54%) or non-Hispanic Black (22%), were included (early stage, n = 538; MBC, n = 47). After the ALAC program, a significant increase in physical activity (P < 0.001), improved physical and mental health T-scores (P < 0.001), and more sit-to-stand repetitions (P < 0.001) were observed for both survivors with early-stage breast cancer and MBC. Women with MBC showed significantly lower physical health (P = 0.037) and physical function (P = 0.010) compared to early-stage at baseline. CONCLUSIONS: The ALAC program increased physical activity and improved health-related quality of life and physical function among breast cancer survivors with both early-stage and metastatic disease. IMPLICATIONS FOR CANCER SURVIVORS: This study emphasizes the importance of incorporating physical activity interventions like the ALAC program into the comprehensive care of cancer survivors, including those with metastatic disease.

Association of cancer diagnosis with disability status among older survivors of colorectal cancer: a population-based retrospective cohort study.

Background: Older cancer survivors likely experience physical function limitations due to cancer and its treatments, leading to disability and early mortality. Existing studies have focused on factors associated with surgical complications and mortality risk rather than factors associated with the development of poor disability status (DS), a proxy measure of poor performance status, in cancer survivors. We aimed to identify factors associated with the development of poor DS among older survivors of colorectal cancer (CRC) and compare poor DS rates to an age-sex-matched, non-cancer cohort. Methods: This retrospective cohort study utilized administrative data from the Texas Cancer Registry Medicare-linked database. The study cohort consisted of 13,229 survivors of CRC diagnosed between 2005 and 2013 and an age-sex-matched, non-cancer cohort of 13,225 beneficiaries. The primary outcome was poor DS, determined by Davidoff's method, using predictors from 12 months of Medicare claims after cancer diagnosis. Multivariable Cox proportional hazards regression was used to identify risk factors associated with the development of poor DS. Results: Among the survivors of CRC, 97% were 65 years or older. After a 9-year follow-up, 54% of survivors of CRC developed poor DS. Significant factors associated with future poor DS included: age at diagnosis (hazard ratio [HR] = 3.50 for >80 years old), female sex (HR = 1.50), race/ethnicity (HR = 1.34 for Hispanic and 1.21 for Black), stage at diagnosis (HR = 2.26 for distant metastasis), comorbidity index (HR = 2.18 for >1), and radiation therapy (HR = 1.21). Having cancer (HR = 1.07) was significantly associated with developing poor DS in the pooled cohorts; age and race/ethnicity were also significant factors. Conclusions: Our findings suggest that a CRC diagnosis is independently associated with a small increase in the risk of developing poor DS after accounting for other known factors. The study identified risk factors for developing poor DS in CRC survivors, including Hispanic and Black race/ethnicity, age, sex, histologic stage, and comorbidities. These findings underscore the importance of consistent physical function assessments, particularly among subsets of older survivors of CRC who are at higher risk of disability, to prevent developing poor DS.

Modulating a prebiotic food source influences inflammation and immune-regulating gut microbes and metabolites: insights from the BE GONE trial.

BACKGROUND: Accessible prebiotic foods hold strong potential to jointly target gut health and metabolic health in high-risk patients. The BE GONE trial targeted the gut microbiota of obese surveillance patients with a history of colorectal neoplasia through a straightforward bean intervention. METHODS: This low-risk, non-invasive dietary intervention trial was conducted at MD Anderson Cancer Center (Houston, TX, USA). Following a 4-week equilibration, patients were randomized to continue their usual diet without beans (control) or to add a daily cup of study beans to their usual diet (intervention) with immediate crossover at 8-weeks. Stool and fasting blood were collected every 4 weeks to assess the primary outcome of intra and inter-individual changes in the gut microbiome and in circulating markers and metabolites within 8 weeks. This study was registered on ClinicalTrials.gov as NCT02843425, recruitment is complete and long-term follow-up continues. FINDINGS: Of the 55 patients randomized by intervention sequence, 87% completed the 16-week trial, demonstrating an increase on-intervention in diversity [n = 48; linear mixed effect and 95% CI for inverse Simpson index: 0.16 (0.02, 0.30); p = 0.02] and shifts in multiple bacteria indicative of prebiotic efficacy, including increased Faecalibacterium, Eubacterium and Bifidobacterium (all p < 0.05). The circulating metabolome showed parallel shifts in nutrient and microbiome-derived metabolites, including increased pipecolic acid and decreased indole (all p < 0.002) that regressed upon returning to the usual diet. No significant changes were observed in circulating lipoproteins within 8 weeks; however, proteomic biomarkers of intestinal and systemic inflammatory response, fibroblast-growth factor-19 increased, and interleukin-10 receptor-α decreased (p = 0.01). INTERPRETATION: These findings underscore the prebiotic and potential therapeutic role of beans to enhance the gut microbiome and to regulate host markers associated with metabolic obesity and colorectal cancer, while further emphasizing the need for consistent and sustainable dietary adjustments in high-risk patients. FUNDING: This study was funded by the American Cancer Society.

Participation in and Satisfaction with a Community-Based Physical Activity Program Among Hispanic Cancer Survivors.

The objective of this study was to explore the experience of Hispanic cancer survivors participating in Active Living After Cancer (ALAC), a community-based physical activity program. We analyzed participation and satisfaction data from 250 participants who completed the program from 2017 to 2020 (55% Hispanic, 28% Black, 14% non-Hispanic White). Using a hybrid coding approach, open-text survey comments responses from Hispanic participants (n = 138) were qualitatively analyzed and key themes developed to better contextualize the quantitative results. Quantitative analysis revealed that Hispanic participants attended an average of 9.44 out of 12 sessions. There were no differences in attendance by race/ethnicity; however, Hispanic participants reported significantly higher overall satisfaction ratings than non-Hispanic White participants (4.93 vs 4.65 on a 5-point scale). Open-ended comments indicated that Hispanic ALAC participants experience collective efficacy, self-efficacy, and self-regulation, through observational learning enabled by program facilitation. The ALAC program is highly acceptable and relevant to Hispanic cancer survivors and will inform the continued expansion of other community-based survivorship programs for Hispanic communities throughout Texas.

Effects of a Pragmatic Home-based Exercise Program Concurrent With Neoadjuvant Therapy on Physical Function of Patients With Pancreatic Cancer: The PancFit Randomized Clinical Trial.

OBJECTIVE: To determine the effects of a preoperative, home-based exercise program on fitness and physical function in patients with pancreatic cancer. BACKGROUND: We previously established a well-tolerated preoperative exercise program after finding a high frequency of sarcopenia and frailty in patients with pancreatic cancer. METHODS: In this randomized, controlled trial (NCT03187951), patients with pancreatic cancer were randomized to Arm A: enhanced usual care or Arm B: prescribed aerobic and resistance exercise during neoadjuvant therapy. Patients received nutrition counseling and activity trackers. The primary endpoint was a 6-minute walk distance (6MWD; ≥14 meters improvement was clinically meaningful). Secondary endpoints included additional physical function tests, health-related quality of life, and clinical outcomes. RESULTS: One hundred fifty-one patients were randomized. Objectively measured weekly activity (153.2±135.6 and 159.8±122.8 min in Arm A and B, respectively, P =0.62) and self-reported weekly moderate-to-strenuous physical activity (107.4±160.4 and 129.6±161.6 min in Arm A and Arm B, respectively, P =0.49) were similar, but weekly strength training sessions increased more in Arm B (by 1.8±1.8 vs 0.1±2.4 sessions, P <0.001). 6MWD improved in both Arm A (mean change 18.6±56.8 m, P =0.01) and Arm B (27.3±68.1 m, P =0.002). Quality of life and clinical outcomes did not significantly differ between arms. Pooling patients in both study groups, exercise, and physical activity was favorably associated with physical performance and clinical outcomes. CONCLUSIONS: In this randomized trial of prescribed exercise versus enhanced usual care during neoadjuvant therapy for pancreatic cancer, a high volume of physical activity and increased exercise capacity were observed in both arms, highlighting the importance of activity among patients preparing for surgery.

Studying the implementation of exercise oncology interventions: a path forward.

Introduction/Purpose: Extensive scientific evidence supports exercise benefits after a cancer diagnosis and the field now needs to focus on elucidating effective strategies for implementing exercise evidence-based interventions (EBIs) for cancer survivors. Methods: This paper brings together three implementation efforts to describe pragmatic observations and strategies when implementing exercise oncology EBIs in non-research settings. From these projects, we report on common implementation barriers and facilitators. We then mapped these observations and strategies on to the phases and processes described in the Exploration, Preparation, Implementation, and Sustainment (EPIS) Framework. Results: The first implementation project used key stakeholders' perspectives to develop a toolkit to implement BEAT Cancer (Better Exercise Adherence after Treatment for Cancer), a self-managed intervention led by fitness professionals. The second project adapted a physical activity behavior change intervention (Active Living after Cancer) for use in the broader community. The third project adapted an in-person exercise intervention in a community setting (Physical Activity and Lymphedema) into an out-patient rehabilitation setting, including home-based intervention elements (Strength After Breast Cancer). We retrospectively collated and operationalized the implementation strategies based on the Experts Recommending Implementation Change (ERIC) study. The most common implementation barriers were related to funding, organizational capacity and training, relationship building, patient referral, and engagement with patients. Conclusions: These implementation strategies provide initial starting points for the implementation of exercise oncology EBIs in clinical and community settings while also serving as examples for future implementation research to advance the translation of exercise oncology evidence.

Using wearable biological sensors to provide personalized feedback to motivate behavioral changes: Study protocol for a randomized controlled physical activity intervention in cancer survivors (Project KNOWN).

Regular physical activity reduces the progression of several cancers and offers physical and mental health benefits for cancer survivors. However, many cancer survivors are not sufficiently active to achieve these health benefits. Possible biological mechanisms through which physical activity could affect cancer progression include reduced systemic inflammation and positive changes in metabolic markers. Chronic and acute hyperglycemia could have downstream effects on cell proliferation and tumorigenesis. One novel strategy to motivate cancer survivors to be more active is to provide personalized biological-based feedback that demonstrates the immediate positive impact of physical activity. Continuous glucose monitors (CGMs) have been used to demonstrate the acute beneficial effects of physical activity on insulin sensitivity and glucose metabolisms in controlled lab settings. Using personal data from CGMs to illustrate the immediate impact of physical activity on glucose patterns could be particularly relevant for cancer survivors because they are at a higher risk for developing type 2 diabetes (T2D). As a pilot project, this study aims to (1) test the preliminary effect of a remotely delivered physical activity intervention that incorporates personalized biological-based feedback on daily physical activity levels, and (2) explore the association between daily glucose patterns and cancer-related insulin pathway and inflammatory biomarkers in cancer survivors who are at high risk for T2D. We will recruit 50 insufficiently active, post-treatment cancer survivors who are at elevated risk for T2D. Participants will be randomly assigned into (1) a group that receives personalized biological feedback related to physical activity behaviors; and (2) a control group that receives standard educational material. The feasibility and preliminary efficacy of this wearable sensor-based, biofeedback-enhanced 12-week physical activity intervention will be evaluated. Data from this study will support the further refinement and enhancement of a more comprehensive remotely delivered physical activity intervention that targets cancer survivors. Trial registration: ClinicalTrials.gov Identifier: NCT05490641.

A Photography-based, Social Media Walking Intervention Targeting Autonomous Motivations for Physical Activity: Semistructured Interviews With Older Women.

BACKGROUND: Older adult women are at risk for negative health outcomes that engaging in sustained physical activity can help prevent. However, promoting long-term maintenance of physical activity in this population has proven to be a challenge. Increasing autonomous motivations (ie, intrinsic, integrated, and identified regulations) for physical activity may facilitate enduring behavior change. Digitally delivered games for health that take a celebratory technology approach, that is, using technology to create new ways to experience valued behaviors and express valued beliefs, may be a useful way to target autonomous motivations for physical activity. Formative research with the target population is needed to design compelling intervention content. OBJECTIVE: The objective of this study is to investigate older adult women's reactions to and thoughts about a photography-based, social media walking game targeting autonomous motivations for physical activity. METHODS: During an individual semistructured interview, a moderator solicited feedback from 20 older adult women (age range 65-74 years) as part of formative research to develop a social media game featuring weekly walking challenges. The challenges were designed to target autonomous motivations for physical activity. Interviews were audio-recorded and transcribed verbatim. Two reviewers conducted thematic content analysis on interview transcripts. RESULTS: We identified 3 overarching themes in qualitative data analysis. These reflected the playful experiences, value, and acceptability associated with the intervention challenges. Generally, participants understood what the challenges were asking them to do, proffered appropriate example responses, and indicated that the challenges would be enjoyable. Participants reported that the intervention content afforded many and varied playful experiences (eg, competition, discovery, exploration, expression, fellowship, humor, nurture, sensation). Further, participants indicated that the intervention increased their motivation for physical activity, occasioned meaningful shifts in perspective, increased their knowledge of various topics of interest, provided an opportunity to create valued connection with others, and provided health-related benefits. Participants suggested the intervention emphasize local history, nature, and cultural events. CONCLUSIONS: The photography-based, social media walking game with relatively simple game mechanics was well received and judged to be apt to bring about a wide variety of emotive experiences. A clear, geographically specific identity emerged as a key driver of interest for intervention content. Taking a celebratory technology approach holds promise for targeting autonomous motivations for physical activity in older adult women.

Exercise Across the Cancer Care Continuum: Why It Matters, How to Implement It, and Motivating Patients to Move.

Annually, nearly 2 million people are diagnosed with cancer. Cancer is the second leading cause of death in the United States. Strong evidence supports exercise in the prevention of seven different types of cancers. Among cancer survivors, exercise across the cancer care continuum is effective at reducing various treatment-related adverse effects, such as fatigue, anxiety, and depression, and improves quality of life, physical function, sleep, and bone health. Considering the benefits of exercise for people living with and beyond cancer, there are several models to facilitate the implementation of exercise as part of the cancer care plan. These models span clinically supervised settings to supervised and nonsupervised community-based settings. Barriers such as payment and workforce development prevent the implementation of these programs nationwide. Oncology providers and cancer care team members also play an important role in promoting exercise to cancer survivors. In fact, a salient theme for motivating survivors to engage in exercise is support from their medical oncologist. Resources and tools are available to help the cancer care team motivate survivors to engage in exercise, such as enhancing enjoyment of the activity, goal-setting, self-monitoring, and social support. Together, exercise is beneficial across the cancer care continuum, and action can be taken right now to facilitate patient and survivor engagement in exercise.

The Online Cancer Nutrition Misinformation: A framework of behavior change based on exposure to cancer nutrition misinformation.

BACKGROUND: Patients with cancer and caregivers increasingly use the internet to find health and lifestyle information, yet online recipes, diet, and nutrition content are unregulated and may be confusing or even misleading. We describe cancer-related nutrition and meal planning information from Pinterest. METHODS: In June 2020, we searched Pinterest using "cancer recipe" and "recipe for cancer" at 3 times daily for 2 weeks. Duplicates were removed for a final sample of n = 103 pins. Each pin was coded for 58 variables including descriptives, cancer claims (eg, treatment, prevention, and cure), and nutrition claims (eg, "turmeric cures cancer"). We summarized each variable to describe the content of cancer nutrition claims on Pinterest and examined associations between claim types and contextual factors, including the use of academic citations, disclaimers, and personal anecdotes. RESULTS: Pinners had on average 116,767 followers (range, 0-1.5 million). Almost half of content sites were for profit (48.5%) and 34% were selling a product. Health claims were common, with content that purported to prevent (41.8%), treat (27.2%), or cure (10.7%) cancer. Vague phrases such as "anti-cancer," "cancer-fighting," or "cancer-busting" were also used. The inclusion of validity indicators including academic citations, disclaimers, and personal anecdotes varied significantly by the types of claims made. Together, these analyses informed the development of a conceptual framework of cancer-related nutrition misinformation. CONCLUSIONS: There are clear financial incentives for the promotion of cancer nutrition information online. More research is needed to understand how exposure to nutrition information can influence patient/caregiver behavior and downstream clinical and psychosocial outcomes.

The Acceptability of an Electronically Delivered Acceptance- and Mindfulness-Based Physical Activity Intervention for Survivors of Breast Cancer: One-Group Pretest-Posttest Design.

BACKGROUND: Survivors of breast cancer can face internal barriers to physical activity, such as uncertainty and frustration stemming from physical limitations, decreased physical functioning, fatigue, and pain. Interventions that draw from the principles of Acceptance and Commitment Therapy (ACT) may help survivors of breast cancer overcome some of the internal barriers associated with physical activity. OBJECTIVE: The primary aim of this study was to investigate the acceptability of an electronically delivered physical activity intervention for survivors of breast cancer, centered on ACT processes. METHODS: This study used a 1-group pretest-posttest design. We recruited 80 insufficiently active female survivors of breast cancer using a web-based recruitment strategy. The 8-week intervention consisted of weekly modules that featured didactic lessons and experiential exercises targeting key ACT processes in the context of physical activity promotion (namely, values, committed action, acceptance, defusion, and contacting the present moment). We determined intervention acceptability according to study retention (≥70%), adherence rates (≥75% of the participants completing ≥50% of the modules), and posttest survey scores reflecting the perceived ease of use, perceived usefulness, and interest and enjoyment of the intervention (≥5 on a 7-point Likert-type scale). We also evaluated changes in self-reported aerobic and muscle strengthening-physical activity, physical activity acceptance, physical activity regulation, and health-related outcomes. RESULTS: The retention rate (61/80, 76%), adherence rate (60/80, 75%), average perceived ease of use (6.17, SD 1.17), perceived usefulness (5.59, SD 1.40), and interest and enjoyment scores (5.43, SD 1.40) met the acceptability criteria. Participants increased their self-reported aerobic physical activity (Cohen d=1.04), muscle strengthening-physical activity (Cohen d=1.02), physical activity acceptance (cognitive acceptance: Cohen d=0.35; behavioral commitment: Cohen d=0.51), physical activity regulation (identified regulation: Cohen d=0.37; integrated regulation: Cohen d=0.66), increased their ability to participate in social roles and activities (Cohen d=0.18), and reported less fatigue (Cohen d=0.33) and sleep disturbance (Cohen d=0.53). CONCLUSIONS: Electronically delivered acceptance- and mindfulness-based interventions may be useful for promoting physical activity in survivors of breast cancer. Further research is needed to refine these approaches and evaluate their effectiveness.

American Cancer Society nutrition and physical activity guideline for cancer survivors.

The overall 5-year relative survival rate for all cancers combined is now 68%, and there are over 16.9 million survivors in the United States. Evidence from laboratory and observational studies suggests that factors such as diet, physical activity, and obesity may affect risk for recurrence and overall survival after a cancer diagnosis. The purpose of this American Cancer Society guideline is to provide evidence-based, cancer-specific recommendations for anthropometric parameters, physical activity, diet, and alcohol intake for reducing recurrence and cancer-specific and overall mortality. The audiences for this guideline are health care providers caring for cancer survivors as well as cancer survivors and their families. The guideline is intended to serve as a resource for informing American Cancer Society programs, health policy, and the media. Sources of evidence that form the basis of this guideline are systematic literature reviews, meta-analyses, pooled analyses of cohort studies, and large randomized clinical trials published since 2012. Recommendations for nutrition and physical activity during cancer treatment, informed by current practice, large cancer care organizations, and reviews of other expert bodies, are also presented. To provide additional context for the guidelines, the authors also include information on the relationship between health-related behaviors and comorbidities, long-term sequelae and patient-reported outcomes, and health disparities, with attention to enabling survivors' ability to adhere to recommendations. Approaches to meet survivors' needs are addressed as well as clinical care coordination and resources for nutrition and physical activity counseling after a cancer diagnosis.

Hunger Training as a Self-regulation Strategy in a Comprehensive Weight Loss Program for Breast Cancer Prevention: A Randomized Feasibility Study.

Weight losses >10% favorably modulate biomarkers of breast cancer risk but are not typically achieved by comprehensive weight loss programs, including the Diabetes Prevention Program (DPP). Combining the DPP with hunger training (HT), an evidence-based self-regulation strategy that uses self-monitored glucose levels to guide meal timing, has potential to enhance weight losses and cancer-related biomarkers, if proven feasible. This two-arm randomized controlled trial examined the feasibility of adding HT to the DPP and explored effects on weight and metabolic and breast cancer risk biomarkers. Fifty postmenopausal women [body mass index (BMI) >27 kg/m2)] at risk of breast cancer were randomized to the DPP+HT or DPP-only arm. Both arms followed a 16-week version of the DPP delivered weekly by a trained registered dietitian. Those in the DPP+HT also wore a continuous glucose monitor during weeks 4-6 of the program. Feasibility criteria were accrual rates >50%, retention rates >80%, and adherence to the HT protocol >75%. All a priori feasibility criteria were achieved. The accrual rate was 67%, retention rate was 81%, and adherence to HT was 90%. Weight losses and BMI reductions were significant over time as were changes in metabolic and breast cancer risk biomarkers but did not vary by group. This trial demonstrated that HT was feasible to add to comprehensive weight management program targeted toward postmenopausal women at high risk of breast cancer, though upon preliminary examination it does not appear to enhance weight loss or metabolic changes. PREVENTION RELEVANCE: This study found that it was feasible to add a short glucose-guided eating intervention to a comprehensive weight management program targeting postmenopausal women at high risk of breast cancer. However, further development of this novel intervention as a cancer prevention strategy is needed.

A Qualitative Examination of COVID-19's Impacts on Physical Activity and Perceptions of Remote Delivery Interventions.

PURPOSE: The COVID-19 pandemic is correlated with decreased physical activity (PA). Transitioning to remote work may impact people's acceptability and preferences for remotely delivered behavioral interventions, including PA. The objective was to examine perceptions of COVID-19 impacts on PA engagement and motivation, and perspectives related to remotely delivered PA interventions. DESIGN: Cross-sectional small-group interview. SETTING: Harris County, Texas. Participants: Insufficiently active, overweight/obese adults (16 healthy adults [aged 25-52 years], and 7 cancer survivors [aged 50-74 years]). METHOD: Group discussion was guided by semi-structured questions. Audio-transcribed data (278 pages) was analyzed using Braun and Clarke's process centering identification, analysis, organization, description, and reports. RESULTS: Overall, participants expressed a decreased level of PA due to the pandemic. Difficulties (e.g., care-taking activities, working from home, and safety concerns) negatively affected motivation. Participants indicated high acceptability of remotely delivered PA interventions, with advantages of virtual technology features (e.g., did not have to maintain a gym membership) and even accountability in maintaining a PA routine (e.g., using virtual groups to engage in community support). CONCLUSION: Participants described COVID-19 negatively affects access to PA opportunities yet also expressed willingness to engage in remotely delivered PA interventions instead of in-person programs because of their COVID-19 experiences. Remote interventions can greatly increase accessibility and offer opportunities to provide personalized motivation and accountability that people need to be more physically active.

Impact of COVID-19 on a worksite weight loss program for employees with overweight and obesity.

Objective: The COVID-19 pandemic has been shown to be negatively associated with physical activity engagement, adherence to healthy diet, and weight management among people with obesity. The current study examined COVID-19-related changes in weight, physical activity (PA), and diet among employees with obesity or overweight who participated in Vibrant Lives (VL), a worksite weight loss program. Methods: School district employees participated in the 6-month VL weight loss program and were categorized into non-COVID-era participants and COVID-era participants. Participants completed questionnaires about PA and dietary intake at baseline and follow-up. COVID-era participants reported the effects of pandemic on their behaviors. Changes in weight, PA, and diet were compared between groups using multilevel linear mixed models and logistic regression models. Results: A total of 266 participants (non-COVID, n=173; COVID, n=93) were included. Significant weight loss (non-COVID, -2.3 kg vs. COVID, -1.3 kg) and increases in moderate-to-vigorous PA minutes (non-COVID, 48.7 min vs. COVID, 61.5 min) were observed associated with the program, but no significant differences in changes between the groups were found. Compared to non-COVID participants, COVID participants decreased fast food consumption (P=.008) and increased sugar-sweetened beverage intake (P=.016). Higher frequency of snacking and overeating were reported as barriers to a healthy diet. Conclusion: The COVID-19 pandemic was negatively associated with healthful dietary behaviors. The information obtained from participants regarding the reasons for their pandemic-related changes in diet may help identify strategies to encourage healthier behaviors and weight management among people who have been negatively affected by the COVID-19 pandemic.This article is protected by copyright. All rights reserved.

Feasibility and Effectiveness of a Worksite-Weight-Loss Program for Cancer Prevention among School-District Employees with Overweight and Obesity.

The effects of Vibrant Lives, a 6-month worksite-weight-loss program, were examined in a cohort of school-district employees with overweight or obesity. The VL Basic (VLB) participants received materials and tailored text messages, the VL Plus (VLP) participants additionally received WIFI-enabled activity monitors and scales and participated in health challenges throughout the school year, and the VL Plus with Support (VLP + S) participants additionally received coaching support. The levels of program satisfaction and retention and changes in weight, physical activity (PA), and diet were compared across groups using Pearson chi-square tests, repeated-measure mixed models, and logistic regression. After the program, the VLB (n = 131), VLP (n = 87), and VLP + S (n = 88) groups had average weight losses of 2.5, 2.5, and 3.4 kg, respectively, and average increases in weekly PA of 40.4, 35.8, and 65.7 min, respectively. The VLP + S participants were more likely than the other participants to have clinically significant weight loss (≥3%; p = 0.026). Compared with the VLB participants, the VLP participants were less likely to meet the recommendations for consuming fast food (p = 0.022) and sugar-sweetened beverages (p = 0.010). The VLP and VLP + S participants reported higher program satisfaction than the VLB participants. The VL program facilitates weight loss among school-district employees with overweight and obesity by increasing their PA and healthy diet.

Changes in physical activity associated with the COVID-19 pandemic in individuals with overweight and obesity: an interrupted time series analysis with historical controls.

The objective of this study was to investigate changes in physical activity patterns associated with the COVID-19 pandemic in individuals with overweight and obesity who were participating in a school district worksite weight loss program. We conducted comparative design interrupted time series analyses on physical activity device (Fitbit) data from the 2018-2019 and 2019-2020 school years (N = 211). We administered a questionnaire in 2020 to supplement device data. After the stay-at-home orders in 2020, participants tended to decrease their weekly step count (B = -1315.7, SE = 627.7, p = .045), decrease their weekly "Lightly active minutes" (B = -39.1, SE = 12.6, p = .007), and increase their weekly "Very active minutes" compared to their counterparts from the year before (B = 7.6, SE = 3.2, p = .020). Decreased motivation, gym closures, and safety concerns were cited as barriers to physical activity. Having more time and health consciousness were cited as facilitators of physical activity. The COVID-19 pandemic was related to changes in physical activity in both positive and negative ways, revealing opportunities to promote healthy lifestyle behaviors in this population. More research is needed to determine optimal approaches to health promotion in the post-COVID-19 era.

Acceptance- and mindfulness-based techniques for physical activity promotion in breast cancer survivors: a qualitative study.

PURPOSE: The purpose of this study was to develop and characterize the relevance and potential utility of an electronically delivered acceptance- and mindfulness-based approaches to physical activity promotion for insufficiently active breast cancer survivors. METHODS: The acceptance- and mindfulness-based physical activity intervention was delivered to participants electronically over the course of 4-8 weeks. It consisted of didactic videos, experiential exercises, and workbook-type activities that targeted principles from acceptance and commitment therapy (ACT). We conducted semi-structured, in-depth interviews with participants after they completed the intervention. Three coders conducted qualitative data analysis on interview transcripts to identify overarching themes and subthemes. RESULTS: We recruited 30 participants. Of those, 16 engaged in an individual interview. The mean age of the sample was 58.4 years (SD = 13.8). The sample was relatively well educated (50.0% college graduates) and mostly overweight or obese (58.8%). We identified two overarching themes from interviews. They were centered on (1) internal and external barriers to physical activity adherence and (2) the utility of targeting core ACT processes (acceptance and defusion, mindfulness, and values clarification) for physical activity promotion. CONCLUSION: Intervention content was perceived to be acceptable, relevant, and to fulfill important needs related to healthy living. Findings suggest that this approach to physical activity promotion can be delivered effectively online. Electronically delivered acceptance- and mindfulness-based approaches hold promise for helping insufficiently active breast cancer survivors increase physical activity.