TON_Sept 2010_steph_v4_TON 9/14/10 4:31 PM Page 38
Survivorship News Physical Activity to the Fore Continued from page 36 the nonexercise group. The researchers call for the study to be expanded in a larger randomized clinical trial. Kerri Winters-Stone, PhD, and her fellow researchers at the College of Health and Human Sciences, Oregon State University, Corvallis, are undertaking a randomized clinical trial comparing aerobic with resistance exercise in sedentary elderly breast cancer survivors (BCS). Preliminary findings after 3 months “show that short-term, low-intensity exercise of any type may improve endurance, strength, and function in older BCS, but gait speed may be more responsive to aerobic exercise,” although more differences between the exercises may only become clear later in the trial. Seventy-nine women are participating in either resistance, aerobic, or a controlled flexibility exercise group. Encouraging cancer survivors to exercise and pursue a healthy lifestyle can be a challenge, especially because interventions must be tailored to factors such as age. Researchers Carolyn B. Rabin, PhD, and Bess H. Marcus, PhD, from the Miriam Hospital/Alpert Medical School of Brown University, Providence, Rhode Island, gathered qualitative and quantitative data from 10 young adult survivors (aged 18-39 years) in an effort to adapt a theoretically grounded webbased exercise intervention to their age group. In addition to goal setting, activity logging, tailored feedback, and other features already tested with sedentary adults, researchers considered the addition of a link to cancer survivor–specific exercise information and an online forum where survivors could communicate with one another. Most surveyed survivors rated the proposed additions positively; some suggested adding an “Ask the Expert” feature and more information on nutrition. When encouraging exercise, is it better to emphasize the pitfalls of a sedentary lifestyle or the joys of fitness? In “The Effects of Framing on Exercise Levels in Colorectal Cancer Survivors,” Isaac M. Lipkus, PhD, and fellow researchers at Duke University, Durham, North Carolina, compared two minimal interventions (a mailed brochure), one with “gain” framing, and another with “loss.” Of the 149 eligible participants recruited from state cancer registries, 137 (92%) early-stage colorectal cancer survivors (6 months to 5 years after diagnosis) completed the 1-month follow-up survey. At baseline, participants engaged in moderate to vigorous exercise an average of 39 minutes per week, which increased to 115 minutes at follow-up. No difference was observed between the two different frames, however; and researchers con-
38
September 2010 I VOL 3, NO 6
cluded that “future research should investigate methods to increase the potency of these interventions to increase further physical activity in this population.” Melissa F. Miller, PhD, MPH, of the Cancer Support Community’s Research and Training Institute, Washington, DC, looked into the way different factors influenced survivor response to Cancer Transitions, a 6-week program that provides cancer survivors exercise and nutrition support. The study evaluated a pilot program at 10 centers from 2007 to 2008. The program was already known to improve health-related quality of life and physical activity, but it was not known what factors made someone more or less receptive to the program. The study investigated predictors of physical and emotional functioning and found that “several factors (weight status, program attendance, income, race, and time since treatment) predicted greater response to Cancer Transitions. Research is needed to evaluate the value of targeting and/or
ity and healthy eating can positively influence lifestyle behaviors and quality of life for African-American breast cancer survivors.” Making physical activity promotion an integral part of follow-up care, rather than something separate or elective, could boost its efficacy. Bernardine M. Pinto, PhD, and fellow researchers at Miriam Hospital/Alpert Medical School of Brown University, Providence, Rhode Island, evaluated the efficacy of Moving Forward with Life, a program that provided oncologists and surgeons with training in giving brief physical activity advice during follow-up visits with BCS. All 192 women received the advice and took part in 12 weeks of telephone counseling. Then, they were randomized into either an extended advice intervention group (based on the Transtheoretical Model and Social-Cognitive Theory) or a brief advice control group. The researchers found that those receiving extended advice were more likely to exercise and increase the number of minutes exercising per week.
“If you take away nothing else from this presentation, it’s that exercise is safe for people to do during breast cancer treatment.” —Kathleen Y. Wolin, ScD
tailoring healthy lifestyle support programs for cancer survivors.” Race and culture can also play a role in survivorship care. M. Tish Knobf, PhD, RN, FAAN, AOCN, and fellow researchers at Yale University piloted a 6-week program to encourage healthy lifestyle and physical activity among African-American BCS. A convenience sample of 40 women was recruited from support groups, hospitals, and community outreach. Preliminary data were presented for 30 women measured for empowerment (Self Efficacy for Exercise), functional ability (MOS SF36), quality of life (Functional Assessment of Cancer Therapy-Breast), and healthy lifestyle (Health Promotion Lifestyle Profile II) at baseline, immediate postprogram, and 3 months later. Improvements were found in quality of life, emotional well-being, health promotion, health responsibility, physical activity, nutrition, and spiritual growth, but not for empowerment or functional ability. The researchers suggest that “a culturally designed psychoeducational intervention focused on physical activ-
Jennifer R. Klemp, PhD, MPH, and fellow researchers at the University of Kansas Medical Center’s Breast Cancer Survivorship Center, Kansas City, presented preliminary evidence suggesting that a 6-month intervention focusing on diet, exercise, and behavioral weight loss in overweight postmenopausal BCS can be effective in reducing weight, achieving favorable biomarker changes, and improving quality of life. Of 84 BCS who had completed chemotherapy at least 3 months before and had a body mass index of 25 to 45, 52 agreed to participate and six did not complete the trial. Participants engaged in 225 minutes a week of moderate-intensity aerobic exercise, light resistance training, a 1200- to 1500-calorie-per-day diet, and group meetings on behavior modification. The researchers used a number of measures to assess participants at baseline and postintervention, including anthropometrics, body composition (dual x-ray absorptiometry), serum biomarkers (insulin, leptin, and adiponectin), fitness test, and survey
questions on eating habits and quality of life. Preliminary data for 32 of the women showed significant weight loss, positive biomarker change, and improved quality of life. Fewer studies have been conducted with lung cancer survivors for obvious reasons: the disease still has a high mortality rate and is characterized by shortness of breath and fatigue. Preliminary findings from a new study show there are significant barriers to recruiting patients for such interventions. In “Feasibility of Implementing a Physical Activity Trial with Sedentary Survivors of Early State, Non–SmallCell Lung Cancer (NSCLC),” Jamie S. Ostroff, PhD, of Memorial SloanKettering Cancer Center, New York, and other researchers recruited 70 sedentary and disease-free survivors between 1 and 10 years after treatment. Participants were separated into a 12-week home-based physical activity program emphasizing walking, upper body and breathing exercises, or a wait-list control group. Of 51 eligible patients, just 28 enrolled. Patients who refused the program were of a similar average age and gender, and cited low motivation for exercise, travel distance to the cancer center, and health concerns. Similarly, in another study, researchers in Denmark found “that patients failed to comply with homebased exercise,” and that supervised exercise was preferable. Emily Jo Rajotte, MPH, of the Fred Hutchinson Cancer Research Center’s Survivorship Program, Seattle, Wash ington, and other researchers undertook a study of a community-based exercise program. They found significant improvements in fatigue, physical function, musculoskeletal symptoms, mental health, social support, blood pressure, weight, waist circumference, strength, and flexibility. The program resulted in few injuries or lymphedema events, and 70% of participants reported continued exercise 6 months later. Exercise and Thrive was a 10-week group exercise program organized by the YMCA of Greater Seattle, Hutchinson Center’s Survivorship Program, and LIVESTRONG. Of 157 survivors observed, pre- and postsurvey and physiologic data were available for 68% of participants. ● References 1. Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med. 2003;348:1625-1638. 2. Ibrahim EM, Al-Homaidh A. Physical activity and survival after breast cancer diagnosis: meta-analysis of published studies. Med Oncol. April 22, 2010. Epub ahead of print. 3. 2008 Physical Activity Guidelines for Americans. Washington, DC: US Dept of Health and Human Services; October 2008. ODPHP Publication No. U0036.
GreeN HILL HeALtHCAre COmmUNICAtIONS