Change in Physical Activity During a Weight Management Intervention for Breast Cancer Survivors: Association with Weight Outcomes.
ABSTRACT: OBJECTIVE:This study examined the effects of a group phone-based weight management intervention on change in physical activity as measured via accelerometer and self-report in rural breast cancer survivors. The study also evaluated the role of physical activity on clinically meaningful cut points for weight loss (baseline to 6 months) and weight loss maintenance (6 to 18 months). METHODS:Participants were breast cancer survivors in a weight management intervention who provided valid weight and accelerometer data (N?=?142). Participants were categorized into four groups based on weight loss??10% and weight regain??5% at 18 months. RESULTS:Accelerometer-measured moderate-to-vigorous physical activity (MVPA) significantly increased from baseline to 6 months (+46.9 minutes). MVPA declined during maintenance but remained significantly greater than baseline. Self-reported MVPA followed a similar pattern as accelerometer MVPA, but estimates were significantly higher. Participants in the high loss, low regain group had significantly higher MVPA at all points. CONCLUSIONS:A distance-based weight management intervention for survivors improved physical activity outcomes over 18 months. Self-reported physical activity was substantially higher than accelerometer measured. Findings highlight the importance of device-based measurement for characterizing the magnitude of physical activity change as well as the role of physical activity in weight management outcomes.
Project description:PURPOSE:Physical activity may be difficult for survivors with poorer functioning following primary treatment. The study examined whether late symptoms of breast cancer treatment impact PA adoption (0-6 months) and maintenance (6-18 months) during a weight management intervention, and whether late symptoms influence PA when accounting for overall functioning. METHODS:Secondary analyses were conducted using a sample of survivors participating in a weight management intervention and who provided valid weight and accelerometer data at baseline and 6 months (N = 176). The Breast Cancer Prevention Trial Symptom Checklist (BCPT) assessed late treatment-related symptoms. SF-12 Physical Component Scale (PCS) and Mental Component Scale (MCS) scores assessed functioning. RESULTS:Change in bouted moderate to vigorous physical activity (MVPA) min/week from baseline to 6 months was not associated with BCPT scales (all p values > 0.05). When adding SF-12 scores to the model, change in bouted MVPA min/week was significantly associated with the PCS (p = 0.045). Change in MVPA min/week from 6 to 18 months was significantly associated with cognitive symptoms (p = 0.004), but not musculoskeletal or vasomotor symptoms (p values > 0.05). When adding 6-month SF-12 scores to the model, MVPA min/week was significantly associated with PCS (p = 0.001) and MCS (p = 0.028); however, BCPT cognitive problems score became non-significant (p > 0.05). CONCLUSIONS:Poorer physical functioning was associated with lower PA adoption, and poorer mental and physical functioning was associated with lower maintenance of PA, while late symptoms generally were not. Interventionists should consider level of functioning when identifying individual PA goals during weight management interventions.
Project description:<h4>Background</h4>Extended intervention contact after an initial, intensive intervention is becoming accepted as best practice in behavioral weight control interventions. Whether extended contact mitigates weight regain in the longer term or it simply delays weight regain until after the extended intervention contact ceases is not clear.<h4>Objective</h4>This study aimed to evaluate, in multiple ways, maintenance of weight, diet, and physical activity outcomes following Get Healthy, Stay Healthy (GHSH), a text message-delivered extended contact intervention.<h4>Methods</h4>Clients completing the Get Healthy Service (GHS) lifestyle telephone coaching program were randomized to receive GHSH (n=114) or standard care (no additional contact, n=114) and were assessed at baseline (following completion of GHS), 6 months (following completion of GHSH), and 12 months (noncontact maintenance follow-up). At all 3 assessments, participants self-reported their body weight, waist circumference, physical activity (walking and moderate and vigorous sessions/week), and dietary behaviors (fruit and vegetable serves/day, cups of sweetened drinks per day, takeaway meals per week; fat, fiber, and total indices from the Fat and Fiber Behavior Questionnaire). Moderate-to-vigorous physical activity (MVPA) was also assessed via accelerometry. Maintenance was examined multiple ways: (1) using traditional methods to assess and compare group averages after some period of noncontact (ie, at 12 months), (2) using a novel approach to assess and compare group average changes over the first 6 months of noncontact, and (3) exploring individual participant changes (increase/decrease/no change) over the first 6 months of noncontact.<h4>Results</h4>Retention over the 12-month trial was high (92.5%, 211/228). Participants had a mean (SD) age of 53.4 (SD 12.3) years and a baseline body mass index of 29.2 (SD 5.9) kg/m<sup>2</sup>. The between-group differences detected at 6 months were still present and statistically significant at 12 months for bodyweight (-1.33 kg [-2.61 to -0.05]) and accelerometer-assessed MVPA (24.9 min/week [5.8-44.0]). None of the other outcomes were significantly favored compared with the control group at 12 months. Changes over their first 6 months of noncontact for the GHSH group were significantly better than the control group in terms of accelerometer-measured MVPA and self-reported moderate activity (other differences between the groups were all nonsignificant). In addition to the maintenance seen in the group averages, most intervention participants had maintained their behavioral outcomes during the first 6 months of noncontact.<h4>Conclusions</h4>The GHSH participants were better off relative to where they were initially, and relative to their counterparts, not receiving extended contact in terms of MVPA. However, based on the between-group difference in bodyweight over the first 6 months of noncontact, GHSH does appear to simply delay the inevitable weight regain. However, this delay in weight regain, coupled with sustained improvements in MVPA, has public health benefits.<h4>Trial registration</h4>Australian New Zealand Clinical Trials Registry ACTRN12613000949785; https://www.anzctr.org. au/Trial/Registration/TrialReview.aspx?id=364821&isReview=true.
Project description:BACKGROUND:Physical activity has beneficial effects on the health of cancer survivors. We aimed to investigate accelerometer-assessed physical activity and sedentary time in cancer survivors, and describe activity profiles. Additionally, we identify demographic and clinical correlates of physical activity, sedentary time and activity profiles. METHODS:Accelerometer, questionnaire and clinical data from eight studies conducted in four countries (n = 1447) were pooled. We calculated sedentary time and time spent in physical activity at various intensities using Freedson cut-points. We used latent profile analysis to identify activity profiles, and multilevel linear regression analyses to identify demographic and clinical variables associated with accelerometer-assessed moderate to vigorous physical activity (MVPA), sedentary time, the highly active and highly sedentary profile, adjusting for confounders identified using a directed acyclic graph. RESULTS:Participants spent on average 26 min (3%) in MVPA and 568 min (66%) sedentary per day. We identified six activity profiles. Older participants, smokers and participants with obesity had significantly lower MVPA and higher sedentary time. Furthermore, men had significantly higher MVPA and sedentary time than women and participants who reported less fatigue had higher MVPA time. The highly active profile included survivors with high education level and normal body mass index. Haematological cancer survivors were less likely to have a highly active profile compared to breast cancer survivors. The highly sedentary profile included older participants, males, participants who were not married, obese, smokers, and those < 12 months after diagnosis. CONCLUSIONS:Cancer survivors engage in few minutes of MVPA and spend a large proportion of their day sedentary. Correlates of MVPA, sedentary time and activity profiles can be used to identify cancer survivors at risk for a sedentary and inactive lifestyle.
Project description:Arterial stiffness is associated with cardiovascular events and mortality. Lifestyle factors such as physical activity (PA) may reduce arterial stiffness. The purpose of this study is to determine the impact of change in PA on 1-year change in arterial stiffness in 274 overweight/obese sedentary young adults. The Slow Adverse Vascular Effects of excess weight (SAVE) trial was a study evaluating the relationships between weight loss, dietary sodium, and vascular health. PA was measured with the ActiGraph AM7164 accelerometer. Intensity of activity was determined using established cut-points. Arterial stiffness was assessed by brachial-ankle pulse wave velocity (baPWV) using an automated device. Analysis of covariance compared changes in total accelerometer counts, minutes/day in light-intensity PA (LPA), moderate-to-vigorous PA (MVPA), and sedentary time, by categories of change in baPWV. Models were adjusted for time since baseline visit, age, sex, race, homeostatis model of assessment of insulin resistance, mean arterial pressure, heart rate, and weight change. Total accelerometer counts and time spent in MVPA increased from baseline to 12 months while time spent in LPA significantly decreased. Mean baPWV was similar at each time point. Those who showed decreased baPWV also showed an increase in total accelerometer counts per day and time spent in MVPA in the fully adjusted models (p<0.001). Changes in sedentary time and time spent in LPA were not associated with changes in baPWV. These results indicate that even modest increases in MVPA can reduce arterial stiffness, a risk factor for future cardiovascular events.
Project description:Objective:Digital self-monitoring of eating, physical activity, and weight is increasingly prescribed in behavioural weight loss programmes. This study determined if adherence rates or associations with outcomes differed according to self-monitoring target (ie, self-monitoring of eating versus physical activity versus weight). Methods:Participants in a 3-month, group-based weight loss programme were instructed to use an app to record food intake, wear a physical activity sensor, and use a wireless body weight scale. At post-treatment, weight loss was measured in clinic and moderate-to-vigorous physical activity (MVPA) was measured by research-grade accelerometer. Results:Adherence to self-monitoring decreased significantly over time for eating and weight but not physical activity. Overall, adherence to self-monitoring of weight was lower than that of eating or physical activity. Greater adherence to self-monitoring of eating, physical activity, and weight each predicted greater weight loss. Only greater adherence to self-monitoring of eating was associated with greater bouted minutes of MVPA. Conclusions:Findings from this study suggest that self-monitoring should be considered a target-specific behaviour rather than a unitary construct when conceptualizing adherence and association with treatment outcomes.
Project description:OBJECTIVE:Age at onset of walking has been shown as an early predictor of physical activity in infants and children. However, little is known about whether age at onset of walking may predict sedentary behavior (SB). The aim of the present study was to examine the association between the timing of onset of walking and objectively measured SB, and whether this association is mediated by moderate-to-vigorous physical activity (MVPA) in children. METHODS:The subjects were 388 elementary school children aged 6-12 years. Current weight and height data were collected. Birth weight and the age in months the child first walked independently were reported based on the parents' recall. Children's SB and physical activity were objectively measured using a triaxial accelerometer (Active style Pro HJA-350IT, OMRON). The following summary outcome variables were derived from accelerometer data: Time (min/day) spent in SB (?1.5 metabolic equivalents [METs]) and MVPA (?3.0 METs). RESULTS:The mean ± SD time (min/day) spent in sedentary was 376 ± 62 and MVPA was 67.6 ± 20.8. Multiple linear regression analyses revealed that a later age at independent walking was associated with increased time spent in SB (? = 0.15, P < 0.001) and decreased time spent in MVPA (? = -0. 18, P < 0.001) after adjusting for gender, birth weight, current age, body weight, schools, and time spent wearing the accelerometer. When MVPA was introduced as a covariate in the model predicting SB, the association between the age at independent walking and time spent in SB was completely attenuated (? = 0.04, P = 0.215), while MVPA was significantly associated with SB (? = -0.61, P < 0.001). CONCLUSIONS:Our results indicate that infants who walked at a later age spent more time in SB in childhood, and this association is mediated by MVPA. Appropriate interventions which focus on increasing MVPA and thereby reducing SB may be beneficial in infants who demonstrate a later age at onset of independent walking.
Project description:<h4>Background</h4>Obesity is associated with worse breast cancer prognosis, however little is known about the level of weight loss required to improve pathway biomarkers. The effects of weight regain on biomarkers are also largely unknown.<h4>Methods</h4>Overweight/obese breast cancer survivors enrolled in an 18-month behavioral weight loss trial provided weight and serum biomarkers [leptin, adiponectin, insulin, plasminogen activator inhibitor-1 (PAI-1), IL-6, TNF?, and hepatocyte growth factor HGF] at baseline, 6, and 18 months (<i>n</i> = 138). Change in biomarkers over time and by weight loss thresholds were examined.<h4>Results</h4>Mean weight loss at 6 months was 13.3 ± 5.0 kg; from 6 to 18 months, mean regain was 4.0 ± 5.2 kg. Favorable biomarker modulations were observed at 6 months for leptin, adiponectin, insulin, PAI-1, IL-6, and HGF (<i>P</i> < 0.006 to <i>P</i> < 0.0001). These changes remained significant overall at 18 months despite attenuation in some. Women who lost <10% of baseline weight showed significantly smaller modulation effects for leptin (<i>P</i> < 0.0001), adiponectin:leptin (A/L) ratio (<i>P</i> < 0.0001), PAI-1 (<i>P</i> < 0.001), and insulin (<i>P</i> = 0.003) compared with women who lost >10%. Women who lost >10% observed a significant increase in adiponectin (<i>P</i> < 0.0001), and these women continued to show improved adiponectin from 6 to 18 months despite weight regain. Physical activity contributed additional effects on biomarker change for leptin, A/L ratio, and PAI-1.<h4>Conclusions</h4>These findings are consistent with a clinical target of 10% weight.<h4>Impact</h4>Sustained increases in adiponectin likely confer benefits for breast cancer prognosis even with weight regain.
Project description:To examine the amount of objectively measured MVPA and LPA that is associated with long-term weight loss and the maintenance of clinically significant weight loss.Adults (N?=?260; BMI: 25 to <40 kg/m(2) ; age: 18-55 years) participated in an 18-month behavioral weight loss intervention and were prescribed a low-calorie diet and increased physical activity. Change in weight and objectively measured physical activity were assessed. MVPA?>?10 (MET-min/week) was computed from bouts >10 min and >3.0 METs and MVPA?<?10 was computed from bouts <10 min in duration and >3.0 METs. LPA was computed from bouts between 1.5 to <3.0 METs.When grouped on percent weight loss at 18 months, there was a significant group × time interaction effect (P?<?0.0001) for both MVPA?>?10 and LPA, with both measures being significantly greater at 18 months in those with >10% weight loss. Similar results were observed for MVPA?>?10 and LPA with participants grouped on achieving >10% weight loss at 6 months and sustaining this at 18 months.MVPA?>?10 of 200-300 min per week, coupled with increased amounts of LPA, are associated with improved long-term weight loss. Interventions should promote engagement in these amounts and types of physical activity.
Project description:OBJECTIVE:The aim of this study was to examine the association between the amount, intensity, and pattern of steps·day-1 with weight loss. METHODS:Participants (N?=?260; age?=?42.8?±?8.9 y; BMI?=?32.8?±?3.5 kg/m2 ) completed an 18-month weight-loss intervention that included a calorie-restricted diet and prescribed physical activity. Participants were categorized by 18-month weight loss as weight gain (GAIN), weight loss of 0% to <?5% (WL?<?5%), 5% to <?10% (WL?<?10%), or???10% (WL???10%). Steps·day-1 were measured at 0, 6, 12, and 18 months and defined as total steps·day-1 , total steps·day-1 of moderate-to-vigorous physical activity (MVPA) (?3 metabolic equivalents) in bouts of ??10 minutes (BOUT-MVPA), MVPA in bouts of <?10 minutes (NON-BOUT-MVPA), or non-MVPA steps·day-1 (NON-MVPA). RESULTS:There was a weight-loss category by time interaction (P?<?0.0001) for total and BOUT-MVPA steps·day-1 . The total steps·day-1 at 18 months were WL???10%?=?9,822 (95% CI: 9,073-10,571), WL?<?10%?=?8,612 (7,613-9,610), WL?<?5%?=?7,802 (6,782-8,822), and GAIN?=?7,801 (6,549-9,053). BOUT-MVPA steps·day-1 at 18 months were WL???10%?=?3,482 (2,982-3,981), WL?<?10%?=?1,949 (1,269-2,629), WL?<?5%?=?1,735 (1,045-2,426), and GAIN?=?1,075 (210-1,941). Participants were also categorized based on achieving???10% weight loss at either 6 or 18 months, and a similar pattern was observed. CONCLUSIONS:These findings show that 10,000 steps·day-1 , with approximately 3,500 steps·day-1 performed as BOUT-MVPA, are associated with enhanced weight loss in a behavioral intervention.
Project description:BACKGROUND:Acceptance-based treatment (ABT) for weight loss has shown promise for improving outcomes relative to standard behavioral treatment (SBT). One way in which ABT may improve outcomes is through increasing physical activity (PA) intentions and behavior but little research has examined these as mediators of ABT on weight change. PURPOSE:This study sought to examine ABT's effects on intentions for PA and several objectively measured PA variables during treatment and analyze PA intentions and behaviors as mediators of ABT's effect on weight loss. METHODS:Participants (N = 189) with overweight/obesity randomized to 1 year of either ABT or SBT completed ecological momentary assessment of PA intentions, accelerometer-based PA assessment, and had weight measured at baseline, mid-treatment, and end of treatment. RESULTS:ABT had a significantly higher increase than SBT in PA intention minutes at mid-treatment and end of treatment (p < 0.001), and both groups had nonlinear increases in moderate-to-vigorous physical activity (MVPA) that were not significantly different. Sequential mediation models found that ABT's effect on weight loss was partially mediated by higher PA intention minutes at mid-treatment leading to increased MVPA minutes per week. Increased MVPA minutes were obtained by participants increasing the number of days with MVPA bouts. CONCLUSIONS:ABT's effect on weight loss throughout treatment resulted, in part, from participants increasing their intentions for PA. Controlling for group, higher PA intentions were associated with more PA obtained through more days with exercise.