ABSTRACT
Purpose: The Cook & Move for Your Life randomized pilot study assessed the feasibility and relative efficacy of two dose levels of a remotely-delivered diet and physical activity (PA) intervention for breast cancer (BC) survivors. Methods: Women with a history of stage 0-III BC who were >60 days post-treatment, ate <5 servings per day of fruits/vegetables or engaged in <150 minutes per week of moderate to vigorous physical activity (MVPA), and had smartphone or computer access were enrolled. Participants were randomized to receive one of two doses of an online diet and PA didactic and experiential program, with outcomes measured at 6 months. The low-dose arm received a single 2-hour Zoom session delivered by a dietitian, a chef, a culinary educator, and an exercise physiologist;the high-dose arm received 12 2-hour Zoom sessions over 6 months. All participants received weekly motivational text messages, a Fitbit to self-monitor PA, and study website access. The primary objective was to evaluate overall feasibility based on accrual, adherence, and retention. Prespecified feasibility endpoints were 75% retention at 6 months and 60% of high-dose arm participants attending at least 8 of the 12 sessions. Secondary objectives were to compare high vs. low dose intervention effects on 6-month changes in fruit/vegetable servings per day (24-hour dietary recall), MVPA minutes per week (accelerometry), and blood and stool biomarkers.Results: From December 2019 to January 2021, 74 women were accrued. On average, women were 57.9 years old, 4.8 years post-diagnosis, with body mass index of 29.1 kg/m2 . Most were nonHispanic white (89.2%), 51.4% were diagnosed at stage I, and 40.5% were on endocrine therapy. Questionnaire and biospecimen data collection at 6-months were completed for 93.2% and 83.8% of the sample, respectively. In the low-dose arm (n=36), 94.4% of participants attended the single class, while in the high-dose arm (n=38) 84.2% of participants attended at least 8 of the 12 sessions live or via video archived on the website (mean 9.4 sessions). On average over the 6-month intervention period, participants responded to 71.5% of the text messages, 73.0% wore their Fitbit device ≥50% of the time, and 77.0% accessed the study website. Mean vegetable intake increased by 1 serving per day among women in the high-dose arm and decreased slightly among women in the low-dose arm (P=0.03). Changes in fruit/vegetable intake and MVPA varied little by arm. Blood and stool biomarker analyses are ongoing. Conclusion: We successfully conducted a remotely-delivered diet and PA intervention for BC survivors with high accrual, adherence, and retention during the COVID-19 pandemic. Women in the high-dose arm increased vegetable intake relative to the low-dose arm. Future research will refine and test the intervention in a larger and more diverse study population.
ABSTRACT
Purpose of the study: The purpose of this study was to investigate the predictors of objectively-measured sedentary time (ST) among breast cancer (BC) survivors who were 60 days post-treatment and were initiating participation in an intervention to improve diet and physical activity (PA) during the early phase of the COVID-19 pandemic. Methods: Cook and Move for Your Life (CMFYL) was a pilot and feasibility study of stage 0-III BC survivors testing the effects of a remotely-delivered and remotely-assessed nutrition and PA intervention. Women were ≥60 days post-treatment (current endocrine therapy allowed), consumed <5 servings of fruits/vegetables per day and/or engaged in <150 minutes/week of moderate to vigorous physical activity (MVPA). Hip-worn Actigraph GT3X accelerometers measured ST for 7 consecutive days at baseline. ST was defined as minutes/day (continuous) based on the Troiano cutpoint (<100 counts/minute), during awake (6am-11pm) wear time, and non-wear was identified using the Choi algorithm on the vector magnitude counts/minute. Multivariable linear regression models adjusting for wear time (average minutes/day) and minutes of MVPA/day were used to examine whether the following factors were predictors of ST at baseline: self-reported demographics, psychosocial factors (assessed via PROMIS Physical Function and PROMIS Anxiety forms), diet quality (Healthy Eating Index 2015 score), caloric intake (calories/day), and fruit and vegetable intake (servings/day). Results: Among the 84 women included in this analysis who had actigraphy measurements at baseline, the average ST/day was 684±79 minutes. On average, women were 58±10 years in age and most self-identified as non-Hispanic white (87%). The average time since diagnosis at time of enrollment was 4.5 years and 59% of women were receiving endocrine therapy at baseline. Adjusted models show that participants with a college degree had 24.7 (95%CI 2.0, 47.4) more minutes of ST than those with less than a college degree, and for every 1-point increase in PROMIS Physical Function scores participants had 2.5 (95%CI -4.9, -0.2) fewer minutes of ST. Conclusion: In a sample of BC survivors enrolled in a diet and PA intervention, higher level of education and poorer physical function were associated with higher ST during the early phase of the COVID-19 pandemic. These findings provide preliminary insight into factors associated with ST. Future work will investigate how these factors influence change in ST after participation in the CMFYL intervention.