Showing papers by "Kerry S. Courneya published in 2017"

Effects of Exercise on Insulin, IGF Axis, Adipocytokines, and Inflammatory Markers in Breast Cancer Survivors: A Systematic Review and Meta-analysis.

Abstract: Background: Insulin, IGF axis, adiponectin, and inflammatory markers are associated with breast cancer. Given that physical activity improves prognosis of breast cancer survivors, we investigated the effects of exercise on these markers as potential mediators between physical activity and breast cancer.Methods: PubMed, EMBASE, CENTRAL, CINAHL, and SportDiscus were searched up to December 3, 2015, to identify randomized controlled trials (RCT) that investigated the effect of exercise on insulin, IGF axis, and cytokines in breast cancer survivors. Weighted mean difference (WMD) was calculated using either fixed- or random-effects models on the basis of the heterogeneity of the studies.Results: A total of 18 studies involving 681 breast cancer survivors were included, and these numbers were reduced for individual biomarker analyses. We found that exercise significantly reduced fasting insulin levels [WMD, -3.46 μU/mL; 95% confidence interval (CI), -5.97 to -0.95; P = 0.007]. Furthermore, potentially meaningful but statistically nonsignificant changes were observed in insulin resistance (WMD, -0.73; 95% CI, -0.54 to 0.13; P = 0.23), adiponectin (WMD, 1.17 μg/mL; 95% CI, -0.87 to 3.20; P = 0.26), and C-reactive protein (WMD, -1.10 mg/L; 95% CI, -2.39 to 0.20; P = 0.10). Subgroup analyses showed that fasting insulin levels were significantly more impacted in studies in which intervention participants experienced a weight reduction (WMD, -7.10 μU/mL; 95% CI, -10.31 to -3.90; P < 0.001).Conclusions: Exercise reduces fasting insulin levels in breast cancer survivors. This may be due to exercise-induced reductions in body weight.Impact: Practitioners and clinicians may better help breast cancer prognosis be improved through exercise, anticipating physiological effects on cancer. Cancer Epidemiol Biomarkers Prev; 26(3); 355-65. ©2016 AACR.

Effects of a multicomponent physical activity behavior change intervention on fatigue, anxiety, and depressive symptomatology in breast cancer survivors: randomized trial

Abstract: Objectives To determine the effects of the 3-month multicomponent Better Exercise Adherence after Treatment for Cancer (BEAT Cancer) physical activity behavior change intervention on fatigue, depressive symptomatology, and anxiety. Methods Postprimary treatment breast cancer survivors (n = 222) were randomized to BEAT Cancer or usual care. Fatigue Symptom Inventory and Hospital Anxiety and Depression Scale were assessed at baseline, postintervention (month 3; M3), and follow-up (month 6; M6). Results Adjusted linear mixed-model analyses demonstrated significant effects of BEAT Cancer vs usual care on fatigue intensity (M3 mean between group difference [M] = −0.6; 95% confidence interval [CI] = −1.0 to −0.2; effect size [d] = −0.32; P = .004), fatigue interference (M3 M = −0.8; CI = −1.3 to −0.4; d = −0.40; P < .001), depressive symptomatology (M3 M = −1.3; CI = −2.0 to −0.6; d = −0.38; P < .001), and anxiety (M3 M = −1.3; CI = −2.0 to −0.5; d = −0.33; P < .001). BEAT Cancer effects remained significant at M6 for all outcomes (all P values <.05; d = −0.21 to −.35). Clinically meaningful effects were noted for fatigue intensity, fatigue interference, and depressive symptomatology. Conclusions BEAT Cancer reduces fatigue, depressive symptomatology, and anxiety up to 3 months postintervention in postprimary treatment breast cancer survivors. Further study is needed to determine sustainable methods for disseminating and implementing the beneficial intervention components.

Effects of high-intensity aerobic interval training on cardiovascular disease risk in testicular cancer survivors: A phase 2 randomized controlled trial.

Abstract: BACKGROUND Testicular cancer survivors (TCS) have an increased risk of treatment-related cardiovascular disease (CVD), which may limit their overall survival. We evaluated the effects of high-intensity aerobic interval training (HIIT) on traditional and novel CVD risk factors and surrogate markers of mortality in a population-based sample of TCS. METHODS This phase 2 trial (ClinicalTrials.gov identifier NCT02459132) randomly assigned 63 TCS to usual care (UC) or 12 weeks of supervised HIIT (ie, alternating periods of vigorous-intensity and light-intensity aerobic exercise). The primary outcome was peak aerobic fitness (VO2peak) assessed via a treadmill-based maximal cardiorespiratory exercise test. Secondary endpoints included CVD risk (eg, Framingham Risk Score), arterial health, parasympathetic nervous system function, and blood-based biomarkers. RESULTS Postintervention VO2peak data were obtained for 61 participants (97%). HIIT participants attended 99% of the exercise sessions and achieved 98% of the target exercise intensity. Analysis of covariance demonstrated that HIIT was superior to UC for improving VO2peak (adjusted between-group mean difference, 3.7 mL O2/kg/min; 95% confidence interval, 2.4-5.1 [P<.001]) and multiple secondary outcomes including CVD risk (P = .011), arterial thickness (P<.001), arterial stiffness (P<.001), postexercise parasympathetic reactivation (P = .001), inflammation (P = .045), and low-density lipoprotein (P = .014). Overall, HIIT reduced the prevalence of modifiable CVD risk factors by 20% compared with UC. CONCLUSIONS This randomized trial provides the first evidence that HIIT improves cardiorespiratory fitness, multiple pathways of CVD risk, and surrogate markers of mortality in TCS. These findings have important implications for the management of TCS. Further research concerning the long-term effects of HIIT on CVD morbidity and mortality in TCS is warranted. Cancer 2017;123:4057-65. © 2017 American Cancer Society.

Physical Activity and Sleep Quality in Breast Cancer Survivors: A Randomized Trial.

Abstract: PurposeData from large randomized controlled trials confirming sleep quality improvements with aerobic physical activity have heretofore been lacking for post–primary treatment breast cancer survivors. Our primary purpose for this report was to determine the effects of a physical activity be

How do different delivery schedules of tailored web-based physical activity advice for breast cancer survivors influence intervention use and efficacy?

Abstract: The purpose of the study is to investigate the impact of differing delivery schedules of computer-tailored physical activity modules on engagement and physical activity behaviour change in a web-based intervention targeting breast cancer survivors. Insufficiently active breast cancer survivors (n = 492) were randomly assigned to receive one of the following intervention schedules over 12 weeks: a three-module intervention delivered monthly, a three-module intervention delivered weekly or a single module intervention. Engagement with the website (number of logins, time on site, modules viewed, action plans completed) was measured using tracking software. Other outcomes (website acceptability, physical activity behaviour) were assessed using online surveys. Physical activity outcomes were analysed using regression models for both study completers and when applying intention-to-treat (using multiple imputation). Completers allocated to the monthly module group rated the intervention higher (b = 2.2 95 % CI = 0.02–4.53) on acceptability and had higher levels of resistance-training (IRR = 1.88, 95 % CI = 1.16–3.04) than those in the single module group. When accounting for missing data, these differences were no longer significant. The completion of at least two action plans was higher among those allocated to the monthly module group compared to those in the weekly module group (53 vs 40 %, p = 0.02); though the completion of at least two modules was higher in the weekly module group compared to the monthly module group (60 vs 46 %; p = 0.01). There were no other significant between group differences observed. This study provides preliminary evidence that web-based computer-tailored interventions can be used to increase physical activity among breast cancer survivors. Further, there were some outcome differences based on how the tailored modules were delivered, with the most favourable outcomes observed in the monthly delivery group. This study will be useful for informing the design of future web-based interventions targeting breast cancer survivors.

Dose-response effects of aerobic exercise on body composition among colon cancer survivors: A randomised controlled trial

Abstract: Physical activity is associated with a lower risk of disease recurrence among colon cancer survivors Excess visceral adipose tissue is associated with a higher risk of disease recurrence among colon cancer survivors The pathways through which physical activity may alter disease outcomes are unknown, but may be mediated by changes in visceral adipose tissue Thirty-nine stage I–III colon cancer survivors were randomised to one of three groups: usual-care control, 150 min wk−1 of aerobic exercise (low dose) and 300 min wk−1 of aerobic exercise (high dose) for 6 months The prespecified key body composition outcome was visceral adipose tissue quantified using dual energy X-ray absorptiometry Exercise reduced visceral adipose tissue in dose–response fashion (Ptrend=0008) Compared with the control group, the low- and high-dose exercise groups lost 95 cm2 (95% CI: –224, 35) and 136 cm2 (95% CI: –270, –01) in visceral adipose tissue, respectively Each 60 min wk−1 increase in exercise predicted a 27 cm2 (95% CI: –54, –01) reduction in visceral adipose tissue Aerobic exercise reduces visceral adipose tissue in dose–response fashion among patients with stage I–III colon cancer Visceral adipose tissue may be a mechanism through which exercise reduces the risk of disease recurrence among colon cancer survivors

Comparison of two accelerometers for measuring physical activity and sedentary behaviour.

Abstract: Purpose A central aspect of physical activity and sedentary behaviour research is accurate exposure assessment in the context of disease outcomes. The primary objectives of this study were to evaluate the convergent validity and test–retest reliability of the ActiGraph GT3X+ and activPAL3 accelerometers. Methods Participants from the Breast Cancer and Exercise Trial in Alberta (n=266) wore both devices concurrently during waking hours for 7 days. Summary measures of time (hours/day) for physical activity and sedentary behaviour were compared between devices using Student’s t-tests. Bland-Altman plots were used to assess or evaluate the mean differences and limits of agreement between monitors, and intraclass correlation coefficients (ICCs) were used to assess the test–retest reliability of two 7-day activity monitor administrations separated by 2 weeks (n=29). Results When comparing the ActiGraph Vector Magnitude (VM), which incorporates all three axes of movement (x, y, z), and the Vertical Axis (VT), which detects movement on the vertical or y-axis only, with the activPAL3, all measures of physical activity were statistically significantly different. The difference in measured time in sedentary behaviour was not statistically significant different when comparing the activPAL3 and ActiGraph (VT) estimates (p=0.47) but was statistically significant different for activPAL3 compared with ActiGraph (VM) (p Conclusion Despite small mean differences and comparable recordings by both devices at the group level, the precision of estimates between methods was low with wide limits of agreement, suggesting these devices may not be used interchangeably for measuring physical activity and sedentary behaviour using common data reduction methods.

Correlates of meeting the combined and independent aerobic and strength exercise guidelines in hematologic cancer survivors.

Abstract: Most previous research on the correlates of physical activity has examined the aerobic or strength exercise guidelines separately. Such an approach does not allow an examination of the correlates of meeting the combined guidelines versus a single guideline, or one guideline versus the other. Here, we report the prevalence and correlates of meeting the combined and independent exercise guidelines in hematologic cancer survivors (HCS). In a population-based, cross-sectional survey of 606 HCS from Alberta, Canada using a mailed questionnaire, we obtained separate assessments of aerobic and strength exercise behaviors, as well as separate assessments for motivations, regulations, and reflective processes using the multi-process action control framework (M-PAC). Overall, 22% of HCS met the combined exercise guideline, 22% met aerobic-only, 10% met strength-only, and 46% met neither exercise guideline. HCS were more likely to meet the combined guideline over the aerobic-only guideline if they had no children living at home, and over both the aerobic and strength-only guidelines if they had completed university. As hypothesized, those meeting the combined guideline also had a more favorable strength-specific M-PAC profile (i.e., motivations, regulations, and reflective processes) than those meeting the aerobic-only guideline, and a more favorable aerobic-specific M-PAC profile than those meeting the strength-only guideline. Interestingly and unexpectedly, HCS meeting the combined guidelines also reported significantly greater aerobic-specific perceived control, planning, and obligation/regret than those meeting the aerobic-only guideline, and greater strength-specific perceived control, planning, and obligation/regret than those meeting the strength-only guideline. Few HCS are meeting the combined exercise guidelines. M-PAC based variables are strong correlates of meeting the combined guidelines compared to aerobic or strength only guidelines. Strategies to help HCS meet the combined guidelines may need to promote more favorable behavioral regulations and reflective processes for both types of exercise rather than just the type of exercise in which HCS are deficient.

Associations of Postdiagnosis Physical Activity and Change from Prediagnosis Physical Activity with Quality of Life in Prostate Cancer Survivors.

Abstract: Background: This prospective study examined the associations between postdiagnosis physical activity and change from prediagnosis physical activity with quality of life (QoL) in prostate cancer survivors. Methods: Prostate cancer survivors ( N = 830) who participated in a case–control study with invasive stage ≥II disease were followed up to 2007 to capture QoL outcomes. At baseline and three time points postdiagnosis (2000–2007), interviews/questionnaires were used to collect data on physical activity, general QoL measured by the SF-36, and other treatment/lifestyle factors. Multivariable linear regression was used to test the relation between postdiagnosis physical activity and QoL as well as the change in physical activity over the diagnostic period and QoL. Results: Both total and recreational physical activities were positively associated with physical QoL. Furthermore, when comparing changes in physical activity levels from pre- to postdiagnosis, men who consistently met physical activity guidelines had significantly higher physical [β = 6.01; 95% confidence interval (CI), 4.15–7.86] and mental (β = 2.32; 95% CI, 0.29–4.34) QoL scores compared with those who did not meet guidelines pre- or postdiagnosis. Furthermore, those who adopted and met guidelines had increased QoL, whereas those who relapsed experienced decreased QoL. Conclusions: Postdiagnosis recreational physical activity is associated with better physical QoL in prostate cancer survivors. Moreover, prostate cancer survivors who maintain or adopt physical activity after diagnosis report substantially higher QoL than men who never exercised or stopped exercising after diagnosis. Impact: Future intervention studies should focus on achieving and maintaining adherence to physical activity guidelines postdiagnosis in prostate cancer survivors. Cancer Epidemiol Biomarkers Prev; 26(2); 179–87. ©2016 AACR .

Evaluation of Online Learning Modules for Improving Physical Activity Counseling Skills, Practices, and Knowledge of Oncology Nurses

Abstract: Purpose/objectives To examine the effectiveness of online learning modules for improving physical activity counseling practices among oncology nurses. . Design Randomized, controlled trial. . Setting Online. . Sample 54 oncology nurses. . Methods Oncology nurses were randomly assigned to the learning modules group or control group. The learning modules group completed six online learning modules and quizzes focused on physical activity for cancer survivors, general physical activity principles, and motivational interviewing. . Main research variables Percentage of cancer survivors counseled, self-efficacy for physical activity counseling, knowledge of physical activity, and perceived barriers and benefits of physical activity counseling. . Findings Analyses of covariance revealed no significant difference between the learning modules and control groups in the percentage of cancer survivors that oncology nurses counseled. Significant differences were found in self-efficacy for physical activity counseling and perceived barriers to physical activity counseling at postintervention. . Conclusions The online learning intervention tested in this study improved some parameters of physical activity counseling but did not increase the percentage of cancer survivors that oncology nurses counseled. Additional pilot work is needed to refine the intervention. . Implications for nursing This study suggests the potential utility of an evidence-based online learning strategy for oncology nurses that includes information on physical activity and its benefits in cancer survivorship. The findings offer a framework on how to implement physical activity counseling skills in oncology nursing practice.

Physical Activity Preferences for People Living With Multiple Myeloma: A Qualitative Study.

Abstract: Although physical activity (PA) has significant benefits for people living with multiple myeloma (MM), participation rates are low. Examination of PA preferences will provide important information to clinicians and assist in the development of interventions to increase participation in PA for people living with MM. The aim of this study is to gain an in-depth understanding of the PA preferences for people living with MM, including the preferred role of clinicians. Semistructured interviews were conducted with patients treated for MM within the preceding 2 to 12 months. Interviews were analyzed using content analysis, where coding categories were derived directly from the text data. Twenty-four interviews were conducted (women, 54%; age: mean [SD], 62 [8.8] years); 16 (67%) participants had an autologous stem cell transplant. Light- to moderate-intensity PA during and after treatment was feasible, with the strongest preference for a program 2 to 8 months after treatment. The timing of information delivery was important, as was input from clinicians and organizations with knowledge of MM. Preferences for location, structure, and timing of programs varied. Low- to moderate-intensity PA after treatment is likely to interest people with MM. Programs need to be flexible and consider individual differences in PA preferences, functional status, and treatment schedules. An individually tailored PA program should form part of clinical care, involving clinicians and organizations with expertise in MM. Options for home-based PA are also important. Further research, including a population-based study of people living with MM, is necessary to further quantify PA preferences.

Dose-Response Effects of Aerobic Exercise on Quality of Life in Postmenopausal Women: Results from the Breast Cancer and Exercise Trial in Alberta (BETA).

Abstract: Exercise generally improves quality of life (QoL) and psychosocial functioning in adult populations but few randomized trials have examined dose-response effects. The purpose of the present study was to report the QoL and psychosocial outcomes from the Breast Cancer and Exercise Trial in Alberta (BETA). Healthy but inactive postmenopausal women at risk for breast cancer were randomized to a year-long aerobic exercise intervention consisting of either 150 min/week (moderate volume group, n = 200) or 300 min/week (high volume group, n = 200). QoL was assessed at baseline and 1 year using the short form-36 health survey. Sleep quality, depression, anxiety, stress, self-esteem, and happiness were also assessed. Participant preference for group assignment (i.e., exercise volume) was assessed at baseline and tested as a moderator. There were no statistically significant dose-response effects of aerobic exercise on any QoL, sleep quality, or psychosocial outcome. Participant preference for group assignment did not moderate any QoL, sleep quality, or psychosocial responses. Marital status was a significant moderator (p for interaction = 0.01) and obesity showed a trend towards being a moderator (p for interaction = 0.08) of the dose-response effects of aerobic exercise on global sleep quality such that unmarried and obese women improved sleep quality with the higher volume of aerobic exercise. A higher volume of aerobic exercise, approximately double the minimum public health guideline, did not provide additional QoL or psychosocial benefits compared to the minimum public health guideline in inactive postmenopausal women, even for women who preferred the higher volume of exercise at baseline. Trial Registration clinicaltrials.gov identifier: NCT1435005.

Dose-response effects of aerobic exercise on energy compensation in postmenopausal women: combined results from two randomized controlled trials

Abstract: Despite the clear health benefits of exercise, exercised-induced weight loss is often less than expected. The term ‘exercise energy compensation’ is used to define the amount of weight loss below what is expected for the amount of exercise energy expenditure. We examined the dose–response effects of exercise volume on energy compensation in postmenopausal women. Data from Alberta Physical Activity and Breast Cancer Prevention (ALPHA) and Breast Cancer and Exercise Trial in Alberta (BETA) were combined for the present analysis. The ALPHA and BETA trials were two-centred, two-armed, 12-month randomized controlled trials. The ALPHA trial included 160 participants randomized to 225 min per week of aerobic exercise, and the BETA trial randomized 200 participants to each 150 and 300 min per week of aerobic exercise. All participants were aged 50–74 years, moderately inactive (<90 min per week of exercise), had no previous cancer diagnosis and a body mass index between 22 and 40 kg m−2. Energy compensation was based on changes in body composition (dual-energy X-ray absorptiometry scan) and estimated exercise energy expenditure from completed exercise volume. Associations between Δenergy intake, ΔVO2peak and Δphysical activity time with energy compensation were assessed. No differences in energy compensation were noted between interventions. However, there were large inter-individual differences in energy compensation between participants; 9.4% experienced body composition changes that were greater than expected based on exercise energy expenditure, 64% experienced some degree of energy compensation and 26.6% experienced weight gain based on exercise energy expenditure. Increases in VO2peak were associated with reductions in energy compensation (β=−3.44 ml kg−1 min−1, 95% confidence interval for β=−4.71 to −2.17 ml kg−1 min−1; P=0.0001). Large inter-individual differences in energy compensation were noted, despite no differences between activity doses. In addition, increases in VO2peak were associated with lower energy compensation. Future studies are needed to identify behavioral and metabolic factors that may contribute to this large inter-individual variability in energy compensation.

A Clinician Referral and 12-Week Exercise Training Program for Men With Prostate Cancer: Outcomes to 12 Months of the ENGAGE Cluster Randomized Controlled Trial.

Abstract: Background:The ENGAGE (efficacy of a referral and physical activity programme for survivors of prostate cancer) study established that a clinician referral and 12-week exercise training programme increased vigorous physical activity at 12 weeks among men with prostate cancer. Here, we report the 6- and 12-month outcomes.Methods:In this multicentre cluster randomised controlled trial, we compared a clinician referral and exercise training programme to usual care. Discounted gym membership was offered to men in the intervention condition on completion of the 12-week exercise programme. Self-reported physical activity at 6 and 12 months was the primary outcome. Quality of life, anxiety, and depressive symptoms were secondary outcomes.Results:A total of 147 men meeting eligibility criteria agreed to participate (54 intervention, 93 control). A positive interaction effect for vigorous physical activity was observed at 6 months, but not 12 months. No significant effects for the secondary outcomes were found.Con...

A pilot study on the motivational effects of an internet-delivered physical activity behaviour change programme in Nova Scotian cancer survivors.

Abstract: Objective: To examine the effects of an internet-delivered, distance-based physical activity (PA) behaviour change programme on motivation to perform PA in cancer survivors.Design: Breast, prostate and colorectal cancer survivors (N = 95) were randomized to either an online Theory of Planned Behaviour (TPB)-based PA behaviour change programme (UCAN) or usual care.Main Outcome Measures: Motivational variables from the TPB including intention, planning, attitude, subjective norm, perceived behavioural control and underlying beliefs.Results: UCAN had significant negative effects on self-efficacy (−.7; 95% CI = −1.2 to −.1; d = −.53, p = .019), affective attitude (−.4; 95% CI = −.8 to −.0; d = −.45, p = .044), instrumental attitude (−.5; 95% CI = −.9 to −.1; d = −.43, p = .026) and confidence to perform PA in bad weather (−.8; 95% CI = −1.6 to −.1; d = −.49, p = .030), despite health issues (−.7; 95% CI = −1.3 to −.1; d = −.48, p = .031), despite pain/soreness (−.7; 95% CI = −1.4 to −.1; d = −.52, p = .020), ...

Social Cognitive Constructs Did Not Mediate the BEAT Cancer Intervention Effects on Objective Physical Activity Behavior Based on Multivariable Path Analysis.

Abstract: Most breast cancer survivors do not meet physical activity recommendations. Understanding mediators of physical activity behavior change can improve interventions designed to increase physical activity in this at-risk population. Study aims were to determine the 3-month Better Exercise Adherence after Treatment for Cancer (BEAT Cancer) behavior change intervention effects on social cognitive theory constructs and the mediating role of any changes on the increase in accelerometer-measured physical activity previously reported. Post-treatment breast cancer survivors (N = 222) were randomized to BEAT Cancer or usual care. Assessments occurred at baseline, 3 months (M3), and 6 months (M6). Adjusted linear mixed model analysis of variance determined intervention effects on walking self-efficacy, outcome expectations, goal setting, and perceived barrier interference at M3. Path analysis determined mediation of intervention effects on physical activity at M6 by changes in social cognitive constructs during the intervention (i.e., baseline to M3). BEAT Cancer significantly improved self-efficacy, goals, negative outcome expectations, and barriers. Total path analysis model explained 24 % of the variance in M6 physical activity. There were significant paths from randomized intervention group to self-efficacy (β = 0.15, p < .05) and barriers (β = −0.22, p < .01). Barriers demonstrated a borderline significant association with M6 physical activity (β = −0.24, p = .05). No statistically significant indirect effects were found. Although BEAT Cancer significantly improved social cognitive constructs, no significant indirect effects on physical activity improvements 3 months post-intervention were observed (NCT00929617).

Endogenous sex hormone exposure and repetitive element DNA methylation in healthy postmenopausal women.

Abstract: Epigenetic mechanisms may help to explain the complex and heterogeneous relation between sex hormones and cancer. Few studies have investigated the effects of sex hormones on epigenetic markers related to cancer risk such as levels of methylation within repetitive DNA elements. Our objective was to describe the association between endogenous sex hormone exposure and levels of LINE-1 and Alu methylation in healthy postmenopausal women. We nested a cross-sectional study within the Alberta Physical Activity and Breast Cancer Prevention Trial (2003–2006). Study participants consisted of healthy postmenopausal women who had never been diagnosed with cancer (n = 289). Sex hormone exposures included serum concentrations of estradiol, estrone, testosterone, androstenedione, and sex hormone-binding globulin. We estimated the participants’ lifetime number of menstrual cycles (LNMC) as a proxy for cumulative exposure to ovarian sex hormones. Buffy coat samples were assessed for DNA methylation. Linear regression was used to model the associations of interest and to control for confounding. Both estradiol and estrone had a significant positive dose–response association with LINE-1 methylation. LNMC was associated with both LINE-1 and Alu methylation. Specifically, LNMC had a non-linear “U-shaped” association with LINE-1 methylation regardless of folate intake and a negative linear association with Alu methylation, but only amongst low folate consumers. Androgen exposure was not associated with either outcome. Current and cumulative estrogen exposure was associated with repetitive element DNA methylation in a group of healthy postmenopausal women. LINE-1 and Alu methylation may be epigenetic mechanisms through which estrogen exposure impacts cancer risk.

A Lifestyle Intervention via Email in Minority Breast Cancer Survivors: Randomized Parallel-Group Feasibility Study.

Abstract: Background: Our data have indicated that minority breast cancer survivors are receptive to participating in lifestyle interventions delivered via email or the Web, yet few Web-based studies exist in this population. Objective: The aim of this study was to examine the feasibility and preliminary results of an email-delivered diet and activity intervention program, “A Lifestyle Intervention Via Email (ALIVE),” delivered to a sample of racial and ethnic minority breast cancer survivors. Methods: Survivors (mean age: 52 years, 83% [59/71] African American) were recruited and randomized to receive either the ALIVE program’s 3-month physical activity track or its 3-month dietary track. The fully automated system provided tools for self-monitoring and goal setting, tailored content, and automated phone calls. Descriptive statistics and mixed-effects models were computed to examine the outcomes of the study. Results: Upon completion, 44 of 71 survivors completed the study. Our “intention-to-treat” analysis revealed that participants in the physical activity track made greater improvements in moderate to vigorous activity than those in the dietary track (+97 vs. +49 min/week, P .05). Process evaluation data indicated that most survivors would recommend ALIVE to other cancer survivors (97%), were satisfied with ALIVE (82%), and felt that ALIVE was effective (73%). However, survivors expressed concerns about the functionality of the interactive emails. Conclusions: ALIVE appears to be feasible for racial and ethnic minority cancer survivors and showed promising results for larger implementation. Although survivors favored the educational content, a mobile phone app and interactive emails that work on multiple email domains may help to boost adherence rates and to improve satisfaction with the Web-based platform. Trial Registration: ClinicalTrials.gov NCT02722850; https://clinicaltrials.gov/ct2/show/NCT02722850 (Archived by WebCite at http://www.webcitation.org/6tHN9VsPh) [JMIR Cancer 2017;3(2):e13]

Exercise guidelines for cancer survivors: are fitness and quality-of-life benefits enough to change practice?

Abstract: Since the mid-1980s, exercise has been tested as an intervention strategy to help cancer patients prepare for treatments, cope with treatments, and recover after treatments. [...]

Identification and prediction of health-related quality of life trajectories after a prostate cancer diagnosis.

Abstract: The aim of our study was to identify physical and mental health-related quality of life (HRQoL) trajectories after a prostate cancer diagnosis and systematically characterize trajectories by behaviours and prognostic factors. Prostate cancer survivors (n = 817) diagnosed between 1997 and 2000 were recruited between 2000 and 2002 into a prospective repeated measurements study. Behavioural/prognostic data were collected through in-person interviews and questionnaires. HRQoL was collected at three post-diagnosis time-points, approximately 2 years apart using the Short Form (SF)-36 validated questionnaire. To identify physical and mental HRQoL trajectories, group-based trajectory modelling was undertaken. Differences between groups were evaluated by assessing influential dropouts (mortality/poor health), behavioural/prognostic factors at diagnosis or during the follow-up. Three trajectories of physical HRQoL were identified including: average-maintaining HRQoL (32.2%), low-declining HRQoL (40.5%) and very low-maintaining HRQoL (27.3%). In addition, three trajectories for mental HRQoL were identified: average-increasing HRQoL (66.5%), above average-declining HRQoL (19.7%) and low-increasing HRQoL (13.8%). In both physical and mental HRQoL, dropout from mortality/poor health differed between trajectories, thus confirming HRQoL and mortality were related. Furthermore, increased Charlson comorbidity index score was consistently associated with physical and mental HRQoL group membership relative to average maintaining groups, while behaviours such as time-varying physical activity was associated with physical HRQoL trajectories but not mental HRQoL trajectories. It was possible to define three trajectories of physical and mental HRQoL after prostate cancer. These data provide insights regarding means for identifying subgroups of prostate cancer survivors with lower or declining HRQoL after diagnosis whom could be targeted for interventions aimed at improving HRQoL.

Designing more engaging computer-tailored physical activity behaviour change interventions for breast cancer survivors: lessons from the iMove More for Life study.

Abstract: Participating in regular physical activity is a recommended cancer recovery strategy for breast cancer survivors. However, tailored support services are not widely available and most survivors are insufficiently active to obtain health benefits. Delivering tailored programs via the Internet offers one promising approach. However, recent evaluations of such programs suggest that major improvements are needed to ensure programs meet the needs of users and are delivered in an engaging way. Understanding participants’ experiences with current programs can help to inform the next generation of systems. The purposes of this study are to explore breast cancer survivor’s perspectives of and experiences using a novel computer-tailored intervention and to describe recommendations for future iterations. Qualitative data from a sub-sample of iMove More for Life study participants were analysed thematically to identify key themes. Participants long-term goals for participating in the program were explored by analysing open-ended data extracted from action plans completed during the intervention (n = 370). Participants negative and positive perceptions of the website and recommendations for improvement were explored using data extracted from open-ended survey items collected at the immediate intervention follow-up (n = 156). The majority of participants reported multi-faceted goals, consisting of two or more outcomes they hoped to achieve within a year. While clear themes were identified (e.g. ‘being satisfied with body weight’), there was considerable variability in the scope of the goal (e.g. desired weight loss ranged from 2 to 30 kg). Participants’ perceptions of the website were mixed, but clear indications were provided of how intervention content and structure could be improved. This study provides insight into how to better accommodate breast cancer survivors in the future and ultimately design more engaging computer-tailored interventions.

A Pilot Randomized, Controlled Trial of a Wall Climbing Intervention for Gynecologic Cancer Survivors.

Abstract: Purpose/objectives To examine the feasibility and preliminary efficacy of an eight-week supervised climbing intervention for gynecologic cancer survivors (GCSs). . Design A pilot randomized, controlled trial. . Setting The Wilson Climbing Center in Edmonton, Alberta, Canada. . Sample 35 GCSs who had completed cancer therapy. . Methods GCSs were randomized to an eight-week (16 session) supervised wall climbing intervention (WCI) (n = 24) or usual care (UC) (n = 11). . Main research variables Feasibility outcomes included recruitment rate, adherence rate, skill performance, and safety. Preliminary efficacy outcomes were objective health-related and functional fitness assessed before and after the eight-week intervention using the Senior Fitness Test. . Findings Median adherence to the WCI was 13.5 of 16 sessions. Most GCSs were proficient on 16 of 24 skill assessment items. No serious adverse events were reported. Based on intention-to-treat analyses, the WCI group was superior to the UC group for the 6-minute walk, 30-second chair stand, 30-second arm curls, sit and reach, 8-foot up-and-go, grip strength-right, and grip strength-left assessments. . Conclusions The Gynecologic Cancer Survivors Wall Climbing for Total Health (GROWTH) Trial demonstrated that an eight-week supervised WCI was safe, feasible, and improved functional fitness in GCSs. Phase II and III trials are warranted to further establish the safety, feasibility, and efficacy of WCIs in cancer survivors. . Implications for nursing Oncology nurses may consider a climbing wall as an alternative type of physical activity for improving functional fitness in GCSs.

An exploratory decision tree analysis to predict physical activity compliance rates in breast cancer survivors.

Abstract: Background: The study of physical activity in cancer survivors has been limited to one cause, one effect relationships. In this exploratory study, we used recursive partitioning to examine ...

The role of the built environment in a randomized controlled trial to increase physical activity among men with prostate cancer: the PROMOTE trial.

Abstract: Purpose The purpose of the study was to examine the association between the built environment and physical activity (PA) in prostate cancer survivors (PCS), as well as whether built environment factors (walkability, count of sports complexes) were effect modifiers of a PA intervention.

Dog ownership and physical activity among breast, prostate, and colorectal cancer survivors.

Abstract: Background Dog ownership has been associated with higher rates of physical activity (PA) in several populations but no study to date has focused on cancer survivors. The purpose of this study was to examine the associations between dog ownership and PA among cancer survivors and to examine correlates of dog ownership. Methods A stratified random sample of 2062 breast cancer survivors, prostate cancer survivors, and colorectal cancer survivors was mailed a questionnaire assessing PA, social cognitive, dog ownership, demographic, and medical variables. Results Overall, 25% of the sample was dog owners (DOs). There were no significant differences in moderate, vigorous, or total PA minutes between DOs and non–dog owners. There was a significant difference in light PA minutes in favor of DOs (153 vs 112 minutes; 95% CI = 4 to 77; P = .030), however, this was largely restricted to breast cancer survivors (143 vs 79 minutes; 95% CI = 25 to 102; P = .001) who also reported fewer vigorous PA minutes (18 vs 39 minutes; 95% CI = −42 to −1; P = .042). Survivors were more likely to be DOs if they had breast cancer (P = .054), a higher income (P = .021), radiation therapy (P = .029), chemotherapy (P = .010), were younger (P < .001), employed (P < .001), and a current smoker (P = .015). Few social cognitive variables were associated with DO. Conclusions Dog ownership among cancer survivors was not associated with moderate‐to‐vigorous PA but was associated with light PA. Further research is necessary to determine if promoting dog ownership and dog walking among cancer survivors may increase PA and possibly improve health outcomes.

Associations between postmenopausal endogenous sex hormones and C-reactive protein: a clearer picture with regional adiposity adjustment?

Abstract: Objective To better understand the pathogenesis of inflammatory-related diseases after menopause, we studied the adiposity-independent association between endogenous sex hormones and C-reactive protein (CRP), a biomarker of inflammation. Methods We conducted a secondary, cross-sectional analysis of baseline data from the Alberta Physical Activity and Breast Cancer Prevention Trial (2003-2007), including 319 healthy, postmenopausal women not using hormone therapy. Multivariable linear regression models related serum CRP levels to estrogens, androgens, and sex hormone-binding globulin (SHBG), all on the natural logarithmic scale. Models were adjusted for age, lipids, medication, and former menopausal hormone therapy use, and also for adiposity (body mass index [BMI], per cent body fat [via whole-body dual x-ray absorptiometry], or intra-abdominal fat area [via computed tomography]). Results Without adiposity adjustment, estrone, total estradiol, and free estradiol were significantly positively associated with CRP, whereas SHBG was significantly inversely associated with CRP. Of all adiposity measures, adjustment for BMI caused the greatest attenuation of CRP-estrogen associations; only free estradiol (β = 0.24, 95% confidence interval [CI] 0.06, 0.43) and SHBG (β = -0.37, 95% CI -0.60, -0.13) associations remained significant. Inverse associations between CRP-total testosterone became stronger with BMI adjustment (β = -0.20, 95% CI -0.40, -0.01). Differential associations across categories of BMI, former hormone therapy use, and years since menopause were suggestive, but not statistically significant (Pheterogeneity > 0.05). Conclusions Prospective and systems epidemiological studies are needed to understand whether or not the cross-sectional associations we observed, independent of adiposity, between CRP-SHBG, CRP-total testosterone, and CRP-free estradiol, are causal.

Physical activity does not alter prolactin levels in post-menopausal women: results from a dose-response randomized controlled trial.

Abstract: Increased circulating levels of prolactin have been associated with increased risk of both in situ and invasive breast cancer. We investigated whether or not physical activity had a dose–response effect in lowering plasma levels of prolactin in postmenopausal women. Four hundred previously inactive but healthy postmenopausal women aged 50–74 years of age were randomized to 150 or 300 min per week of aerobic physical activity in a year-long intervention. Prolactin was measured from fasting samples with a custom-plex multiplex assay. A high compared to moderate volume of physical activity did not reduce plasma prolactin levels in intention-to-treat (Treatment Effect Ratio (TER) 1.00, 95% Confidence Interval (CI) 0.95 – 1.06) or per-protocol analyses (TER 1.02, 95% CI 0.93 – 1.13). It is unlikely that changes in prolactin levels mediate the reduced risk of breast cancer development in post-menopausal women associated with increased levels of physical activity. clinicaltrials.gov identifier: NCT01435005 .