Showing papers by "Carolyn C. Gotay published in 2017"

Does obesity modify the relationship between physical activity and breast cancer risk

Abstract: With only 5–10% of breast cancer cases attributed to genetic inheritance, prevention efforts have focused on modifiable risk factors. Physical activity plays a role in reducing breast cancer risk; however, the interaction between physical activity and other modifiable risk factors, such as obesity, has received little attention. A systematic review and meta-analysis was conducted of studies examining the relationship between physical activity and breast cancer and how it may be modified by body mass index (BMI). A total of 29 papers were included: 18 were cohort and 11 were case–control studies. Overall, a significant reduction in the relative risk of breast cancer was found in postmenopausal women with high versus low levels of physical activity for women with a BMI <25 kg/m2 (RR 0.85, 95% CI 0.79, 0.92) and ≥25 kg/m2 (RR 0.87, 95% CI 0.81, 0.93) but not ≥30 kg/m2 (RR: 0.93, 95% CI 0.76, 1.13). Physical activity was not associated with a significant reduction in risk of breast cancer in premenopausal women in any BMI group. The results of this meta-analysis suggest that physical activity is associated with a larger breast cancer risk reduction among women who are normal weight or overweight than among women who are obese. Since the included studies used diverse methods for assessment of physical activity and categories of BMI, results should be interpreted with caution and additional work is needed.

Feasibility of a telephone and web-based physical activity intervention for women shift workers.

Abstract: INTRODUCTION Shift work (an occupation requiring work between 2200 and 0500H) comprises approximately 20% of the workforce in Europe and North America [1]. This is likely to increase, with many shift workers (SWs) in emergency services, retail, hospitality, healthcare, transportation and manufacturing [2]. SWs are at increased risk for negative health outcomes, including cancer and other chronic diseases [3, 4]. Biological changes from poor lifestyle habits related to shift work (e.g. low physical activity (PA), poor nutrition, obesity) are thought to contribute to this risk; these factors are also amenable to lifestyle intervention [5]. PA in particular, reduces cancer risk [6], and has many positive physical and psychological benefits [7]. It is a simple, cost-effective strategy that may be implemented by individual workers or within workplaces to mitigate risk. Unfortunately, SWs are unlikely to engage in regular PA [8]. In Canada, only 15.9% of SWsmeet the PA guidelines and have lower levels of aerobic fitness than those of day workers [9]. Few behavioural interventions improving health outcomes in SWs have been published [10]. In a targeted PA intervention, nurses randomised to 4 months of supervised PA improved aerobic fitness, muscular strength, fatigue and musculoskeletal symptoms. However, authors reported low adherence and large loss to follow-up, perhaps due to the supervised scheduled sessions [11, 12]. Sustained behaviour change is a challenge and requires targeted efforts to encourage individuals to reach an adequate dose of PA to change health outcomes [13]. Due to irregular schedules and time constraints, SWs may be less likely to adhere to a traditional supervised PA intervention with face-to-face behavioural support [12]. Women SWs cite work schedule interference and lack of time as PA barriers and report scheduling flexibility as the most important in PA [14]. This highlights the need for a creative and innovative programming to promote PA in SWs. Distance-based interventions, in which individuals exercise independent of study staff or participants, may include telephone counselling and website or smart phone app-based technology. These interventions are highly flexible and may help overcome barriers related to timing and scheduling that are important for SWs. In a review of telephone-based PA interventions, 14 of 17 found evidence for behaviour change [15]. These may be a way to implement scalable, individuallytailored interventions in SWs. The primary objective of this study was to test the feasibility of a distance-based PA intervention in women SWs. Feasibility studies are important for establishing effective processes and understanding resources required before attempting a randomised controlled trial (RCT), in order to put forward interventions that are most likely to be efficacious [16]. As this work was funded by a grant to examine the role of lifestyle in reducing breast cancer risk in SWs, only women were included. A secondary objective was to conduct a preliminary evaluation of intervention efficacy, to estimate effect size for future studies.

Utilization of bone mineral density testing among breast cancer survivors in British Columbia, Canada.

Abstract: Breast cancer survivors are at high osteoporosis risk. Bone mineral density testing plays a key role in osteoporosis management. We analyzed a historical utilization of bone mineral density testing in breast cancer survivors. The utilization remained low in the 1995–2008 period. Lower socio-economic status and rural residency were associated with lower utilization. To evaluate the utilization of bone mineral density (BMD) testing for female breast cancer survivors aged 65+ surviving ≥ 3 years in British Columbia, Canada. A retrospecitve population-based data linkage study. Trends in proportion of survivors with ≥ 1 BMD test for each calendar year from 1995 to 2008 were evaluated with a serial cross-sectional analysis. Associations between factors (socio-demographic and clinical) and BMD testing rates over the period 2006–2008 for 7625 survivors were evaluated with a cross-sectional analysis and estimated as adjusted prevalence ratios (PRadj) using log-binomial models. Proportions of survivors with ≥ 1 BMD test increased from 1.0% in 1995 to 10.1% in 2008. The BMD testing rate in 2006–2008 was 26.5%. Socio-economic status (SES) and urban/rural residence were associated with BMD testing rates in a dose-dependent relationship (p for trend< 0.01). Survivors with lower SES (PRadj = 0.66–0.78) or rural residence (PRadj = 0.70) were 20–30% less likely to have BMD tests, compared with survivors with the highest SES or urban residence. BMD testing rates were also negatively associated with older age (75+) (PRadj = 0.47; 95% CI = 0.42, 0.52), nursing home residency (0.05; 0.01, 0.39), recent osteoporotic fractures (0.21; 0.14, 0.32), and no previous BMD tests (0.26; 0.23, 0.29). Utilization of BMD testing was low for breast cancer survivors in BC, Canada. Lower SES and rural residence were associated with lower BMD testing rates. Female breast cancer survivors, especially those with lower SES or rural residence, should be encouraged to receive BMD tests as recommended by Canadian guidelines.

Acceptability and satisfaction of project move: A pragmatic feasibility trial aimed at increasing physical activity in female breast cancer survivors

Abstract: Objective: Despite the physical and psychological health benefits associated with physical activity (PA) for breast cancer (BC) survivors, up to 70% of female BC survivors are not meeting minimum recommended PA guidelines. The objective of this study was to evaluate the acceptability and satisfaction with Project MOVE, an innovative approach to increase PA among BC survivors through the combination of microgrants and financial incentives. Methods: A mixed-methods design was used. Participants were BC survivors with a mean age of 58.5 years. At 6 month follow-up, participants (n=72) completed a program evaluation questionnaire and participated in focus groups (n=10) to explore their experience with Project MOVE. Results: Participants reported that they were satisfied with Project MOVE (88%) and that the program was appropriate for BC survivors (92%). Four main themes emerged from the focus groups: 1) Acceptability and satisfaction of Project MOVE, detailing the value of the model in developing tailored group-based PA programs; 2) The importance of Project MOVE leaders, highlighting the importance of a leader with knowledge and experience concerning PA for BC survivors, 3) Breaking down barriers with Project MOVE, describing how the program helped to address common BC related barriers (i.e., body image) as well as practical barriers (i.e.,cost), and 4) Motivation to MOVE, outlining how the microgrants enabled survivors to be active, while the financial incentive motivated them to increase and maintain their PA. Conclusion: The findings provide support for the acceptability of Project MOVE as a strategy for increasing PA among BC survivors.Acknowledgments: This work was supported by the Canadian Cancer Society (grant #702913)