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Zhang S, Chou LN, Swartz MD, Mehta HB, Goodwin JS, Kuo YF, Giordano SH, Tucker CA, Basen-Engquist KM, Lyons EJ, Downer B, Peterson SK, Cao T, Swartz MC. Association of cancer diagnosis with disability status among older survivors of colorectal cancer: a population-based retrospective cohort study. Front Oncol 2024; 14:1283252. [PMID: 38559557 PMCID: PMC10978737 DOI: 10.3389/fonc.2024.1283252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/29/2024] [Indexed: 04/04/2024] Open
Abstract
Background Older cancer survivors likely experience physical function limitations due to cancer and its treatments, leading to disability and early mortality. Existing studies have focused on factors associated with surgical complications and mortality risk rather than factors associated with the development of poor disability status (DS), a proxy measure of poor performance status, in cancer survivors. We aimed to identify factors associated with the development of poor DS among older survivors of colorectal cancer (CRC) and compare poor DS rates to an age-sex-matched, non-cancer cohort. Methods This retrospective cohort study utilized administrative data from the Texas Cancer Registry Medicare-linked database. The study cohort consisted of 13,229 survivors of CRC diagnosed between 2005 and 2013 and an age-sex-matched, non-cancer cohort of 13,225 beneficiaries. The primary outcome was poor DS, determined by Davidoff's method, using predictors from 12 months of Medicare claims after cancer diagnosis. Multivariable Cox proportional hazards regression was used to identify risk factors associated with the development of poor DS. Results Among the survivors of CRC, 97% were 65 years or older. After a 9-year follow-up, 54% of survivors of CRC developed poor DS. Significant factors associated with future poor DS included: age at diagnosis (hazard ratio [HR] = 3.50 for >80 years old), female sex (HR = 1.50), race/ethnicity (HR = 1.34 for Hispanic and 1.21 for Black), stage at diagnosis (HR = 2.26 for distant metastasis), comorbidity index (HR = 2.18 for >1), and radiation therapy (HR = 1.21). Having cancer (HR = 1.07) was significantly associated with developing poor DS in the pooled cohorts; age and race/ethnicity were also significant factors. Conclusions Our findings suggest that a CRC diagnosis is independently associated with a small increase in the risk of developing poor DS after accounting for other known factors. The study identified risk factors for developing poor DS in CRC survivors, including Hispanic and Black race/ethnicity, age, sex, histologic stage, and comorbidities. These findings underscore the importance of consistent physical function assessments, particularly among subsets of older survivors of CRC who are at higher risk of disability, to prevent developing poor DS.
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Affiliation(s)
- Shiming Zhang
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Lin-Na Chou
- Department of Biostatistics and Data Science, The University of Texas Medical Branch, Galveston, TX, United States
| | - Michael D. Swartz
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
| | - Hemalkumar B. Mehta
- Department of Epidemiology, John Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - James S. Goodwin
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX, United States
| | - Yong-Fang Kuo
- Department of Biostatistics and Data Science, The University of Texas Medical Branch, Galveston, TX, United States
| | - Sharon Hermes Giordano
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Carole A. Tucker
- Department of Physical Therapy, The University of Texas Medical Branch, Galveston, TX, United States
| | - Karen M. Basen-Engquist
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Elizabeth J. Lyons
- Department of Nutrition, Metabolism and Rehabilitation Sciences, The University of Texas Medical Branch, Galveston, TX, United States
| | - Brian Downer
- Department of Population Health and Health Disparities, The University of Texas Medical Branch, Galveston, TX, United States
| | - Susan K. Peterson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Tru Cao
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States
| | - Maria C. Swartz
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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Robertson MC, Cox-Martin E, Basen-Engquist K, Lyons EJ. Reflective Engagement With a Digital Physical Activity Intervention Among People Living With and Beyond Breast Cancer: Mixed Methods Study. JMIR Mhealth Uhealth 2024; 12:e51057. [PMID: 38335025 PMCID: PMC10891490 DOI: 10.2196/51057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/21/2023] [Accepted: 12/07/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND People living with and beyond breast cancer can face internal barriers to physical activity (eg, fatigue and pain). Digital interventions that promote psychological acceptance and motivation may help this population navigate these barriers. The degree to which individuals (1) adhere to intervention protocols and (2) reflect on and internalize intervention content may predict intervention efficacy. OBJECTIVE The objective of this study was to characterize the nature of reflective processes brought about by an 8-week acceptance- and mindfulness-based physical activity intervention for insufficiently active survivors of breast cancer (n=75). Furthermore, we explored the potential utility of a metric of reflective processes for predicting study outcomes. METHODS Of the intervention's 8 weekly modules, 7 (88%) included an item that asked participants to reflect on what they found to be most useful. Two coders conducted directed content analysis on participants' written responses. They assessed each comment's depth of reflection using an existing framework (ranging from 0 to 4, with 0=simple description and 4=fundamental change with consideration of social and ethical issues). The coders identified themes within the various levels of reflection. We fit multiple linear regression models to evaluate whether participants' (1) intervention adherence (ie, number of modules completed) and (2) the mean level of the depth of reflection predicted study outcomes. RESULTS Participants were aged on average 57.2 (SD 11.2) years, mostly non-Hispanic White (58/75, 77%), and mostly overweight or obese (54/75, 72%). Of the 407 responses to the item prompting personal reflection, 70 (17.2%) were rated as reflection level 0 (ie, description), 247 (60.7%) were level 1 (ie, reflective description), 74 (18.2%) were level 2 (ie, dialogic reflection), 14 (3.4%) were level 3 (ie, transformative reflection), and 2 (0.5%) were level 4 (ie, critical reflection). Lower levels of reflection were characterized by the acquisition of knowledge or expressing intentions. Higher levels were characterized by personal insight, commentary on behavior change processes, and a change of perspective. Intervention adherence was associated with increases in self-reported weekly bouts of muscle-strengthening exercise (B=0.26, SE 0.12, 95% CI 0.02-0.50) and decreases in sleep disturbance (B=-1.04, SE 0.50, 95% CI -0.06 to -2.02). The mean level of reflection was associated with increases in psychological acceptance (B=3.42, SE 1.70, 95% CI 0.09-6.75) and motivation for physical activity (ie, integrated regulation: B=0.55, SE 0.25, 95% CI 0.06-1.04). CONCLUSIONS We identified a useful method for understanding the reflective processes that can occur during digital behavior change interventions serving people living with and beyond breast cancer. Intervention adherence and the depth of reflection each predicted changes in study outcomes. Deeper reflection on intervention content was associated with beneficial changes in the determinants of sustained behavior change. More research is needed to investigate the relations among digital behavior change intervention use, psychological processes, and intervention efficacy.
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Affiliation(s)
- Michael C Robertson
- Department of Family and Preventive Medicine, TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Department of Nutrition, Metabolism & Rehabilitation Sciences, University of Texas Medical Branch at Galveston, Galveston, TX, United States
| | | | - Karen Basen-Engquist
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Elizabeth J Lyons
- Department of Nutrition, Metabolism & Rehabilitation Sciences, University of Texas Medical Branch at Galveston, Galveston, TX, United States
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Robertson MC, Downer B, Schulz PE, Samper-Ternent R, Lyons EJ, Milani SA. Social and Leisure Activities Predict Transitions in Cognitive Functioning in Older Mexican Adults: A Latent Transition Analysis of the Mexican Health and Aging Study. J Gerontol B Psychol Sci Soc Sci 2023; 78:1625-1635. [PMID: 37227927 PMCID: PMC10561883 DOI: 10.1093/geronb/gbad082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVES Mexico has a rapidly aging population at risk for cognitive impairment. Social and leisure activities may protect against cognitive decline in older adults. The benefits of these behaviors may vary by patterns of cognitive impairment. The objectives of this study were to identify latent states of cognitive functioning, model the incidence of transitions between these states, and investigate how social and leisure activities were associated with state transitions over a 6-year period in Mexican adults aged 60 and older. METHODS We performed latent transition analyses to identify distinct cognitive statuses in the 2012 and 2018 waves of the Mexican Health and Aging Study (N = 9,091). We examined the transition probabilities between these states and their associations with social and leisure activities. RESULTS We identified 4 cognitive statuses at baseline: normal cognition (43%), temporal disorientation (30%), perceptual-motor function impairment (7%), and learning and memory impairment (20%). Various social and leisure activities were associated with reduced odds of death and disadvantageous cognitive transitions, as well as increased odds of beneficial transitions. DISCUSSION Mapping the effects of popular social and leisure activities onto common patterns in cognitive functioning may inform the development of more enjoyable and effective health-protective behavioral interventions.
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Affiliation(s)
- Michael C Robertson
- Department of Nutrition, Metabolism & Rehabilitation Sciences; The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Brian Downer
- Department of Population Health & Health Disparities, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Paul E Schulz
- Department of Neurology, The McGovern Medical School of UTHealth Houston, Texas, USA
| | - Rafael Samper-Ternent
- Department of Management, Policy & Community Health, UTHealth Houston School of Public Health, Houston, Texas, USA
| | - Elizabeth J Lyons
- Department of Nutrition, Metabolism & Rehabilitation Sciences; The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Sadaf Arefi Milani
- Department of Epidemiology, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
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Swartz MC, Robertson MC, Christopherson U, Wells SJ, Lewis ZH, Bai J, Swartz MD, Silva HC, Martinez E, Lyons EJ. Assessing the Suitability of a Virtual 'Pink Warrior' for Older Breast Cancer Survivors during COVID-19: A Pilot Study. Life (Basel) 2023; 13:574. [PMID: 36836931 PMCID: PMC9965453 DOI: 10.3390/life13020574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023] Open
Abstract
The COVID-19 pandemic impacted the conduct of in-person physical activity (PA) interventions among older survivors of BC, who need such interventions to stay active and prevent functional decline. We tested the feasibility of virtually delivering an exergame-based PA intervention to older BC survivors. We enrolled 20 female BC survivors ≥55 years and randomly assigned them to two groups. The intervention group (Pink Warrior 2) received 12 weekly virtual exergame sessions with behavioral coaching, survivorship navigation support, and a Fitbit for self-monitoring. The control group received 12 weekly phone-based survivorship discussion sessions and wore a Mi Band 3. Feasibility was evaluated by rates of recruitment (≥0.92 participants/center/month), retention (≥80%), and group attendance (≥10 sessions), percentage of completed virtual assessments, and number of technology-related issues and adverse events. Intervention acceptability was measured by participants' ratings on a scale of 1 (strongly disagree) to 5 (strongly agree). The recruitment rate was 1.93. The retention and attendance rates were 90% and 88% (≥10 sessions), respectively. Ninety-six percent completed virtual assessments without an adverse event. Acceptability was high (≥4). The intervention met benchmarks for feasibility. Additional research is needed to further understand the impact of virtually delivered PA interventions on older BC survivors.
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Affiliation(s)
- Maria C. Swartz
- Department of Pediatrics Research, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Michael C. Robertson
- Department of Nutrition, Metabolism & Rehabilitation Sciences, The University of Texas Medical Branch, Galveston, TX 77550, USA
| | - Ursela Christopherson
- Department of Nutrition, Metabolism & Rehabilitation Sciences, The University of Texas Medical Branch, Galveston, TX 77550, USA
| | - Stephanie J. Wells
- Department of Pediatrics Research, Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Zakkoyya H. Lewis
- Department of Kinesiology & Health Promotion, California State Polytechnic University, Pomona, CA 91768, USA
| | - Jinbing Bai
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA
| | - Michael D. Swartz
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health, Houston, TX 77030, USA
| | - H. Colleen Silva
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX 77550, USA
| | - Eloisa Martinez
- Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX 77550, USA
| | - Elizabeth J. Lyons
- Department of Nutrition, Metabolism & Rehabilitation Sciences, The University of Texas Medical Branch, Galveston, TX 77550, USA
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Swartz MC, Lewis ZH, Deer RR, Stahl AL, Swartz MD, Christopherson U, Basen-Engquist K, Wells SJ, Silva HC, Lyons EJ. Feasibility and Acceptability of an Active Video Game-Based Physical Activity Support Group (Pink Warrior) for Survivors of Breast Cancer: Randomized Controlled Pilot Trial. JMIR Cancer 2022; 8:e36889. [PMID: 35994321 PMCID: PMC9446134 DOI: 10.2196/36889] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 07/01/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Survivors of breast cancer with functional limitations have a 40% higher mortality rate than those without. Despite the known benefits of physical activity (PA), <40% of survivors of breast cancer meet the recommendations for PA. The combination of active video games (AVGs) and group-based PA counseling may hold potential for motivating PA adoption and improving physical function. However, this method has not been widely studied in survivors of breast cancer. OBJECTIVE We aimed to determine the feasibility and acceptability of a group AVG-based multicomponent PA intervention and estimate its effect size and variability on PA and physical function in female survivors of breast cancer in a clinic setting. METHODS Female survivors of breast cancer (N=60) were recruited through the clinic and randomly assigned to the intervention group (12 weekly sessions) or the control group (existing support group). The intervention group received game-based pedometers and participated in weekly group AVG sessions, PA behavioral coaching, and survivorship navigation discussions. A participant manual with weekly reflection worksheets was provided to reinforce the coaching lessons and promote self-led PA. The control group received conventional pedometers and participated in an existing breast cancer support group. Feasibility was assessed by enrollment rate (≥50%), retention rate (≥80%), group attendance rate (75% attending ≥9 sessions [intervention group]), and the number of technological issues and adverse events. Acceptability was measured by participants' attitudes (from strongly disagree=1 to strongly agree=5) toward the use of AVGs and the overall program. The outcomes included PA (accelerometers) and physical function (Short Physical Performance Battery and gait speed). Analysis of covariance was used to determine differences in PA and physical function between the groups. The Cohen d and its 95% CI determined the effect size and variability, respectively. All the analyses followed the intention-to-treat principle. RESULTS Participants were an average of 57.4 (SD 10.5) years old, 70% (42/60) White, and 58% (35/60) off treatment. The enrollment rate was 55.9% (66/118). Despite substantial long-term hurricane-related disruptions, we achieved an 80% (48/60) retention. The intervention group's attendance rate was 78% (14/18), whereas the control group's attendance rate was 53% (9/17). Of the 26 game-based pedometers, 3 (12%) were damaged or lost. No study-related adverse events occurred. Acceptability items were highly rated. Steps (β=1621.64; P=.01; d=0.72), Short Physical Performance Battery (β=.47; P=.01; d=0.25), and gait speed (β=.12; P=.004; d=0.48) had a significant intervention effect. CONCLUSIONS The intervention was feasible and acceptable in this population despite the occurrence of a natural disaster. Pilot results indicate that group AVG sessions, PA coaching, and survivorship navigation produced moderate effects on PA and physical functioning. AVGs with PA counseling can potentially be used in existing breast cancer support groups to encourage PA and improve physical function. TRIAL REGISTRATION ClinicalTrials.gov NCT02750241; https://clinicaltrials.gov/ct2/show/NCT02750241.
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Affiliation(s)
- Maria C Swartz
- Department of Pediatrics-Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Zakkoyya H Lewis
- Department of Kinesiology & Health Promotion, California State Polytechnic University, Pomona, Pomona, CA, United States
| | - Rachel R Deer
- Department of Nutrition, Metabolism and Rehabilitation Sciences, Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX, United States
| | - Anna L Stahl
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, United States
| | - Michael D Swartz
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, United States
| | - Ursela Christopherson
- Department of Nutrition, Metabolism and Rehabilitation Sciences, The University of Texas Medical Branch, Galveston, TX, United States
| | - Karen Basen-Engquist
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Stephanie J Wells
- Department of Pediatrics-Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - H Colleen Silva
- Department of Surgery, The University of Texas Medical Branch, Houston, TX, United States
| | - Elizabeth J Lyons
- Department of Nutrition, Metabolism and Rehabilitation Sciences, Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX, United States
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Bentley JR, Yu X, Karmarkar AM, Downer B, Prochaska J, Lyons EJ. Feasibility and thematic analysis of narrative visualization materials with physical activity monitoring among breast cancer survivors. BMC Cancer 2022; 22:553. [PMID: 35578196 PMCID: PMC9112443 DOI: 10.1186/s12885-022-09629-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 05/03/2022] [Indexed: 11/10/2022] Open
Abstract
Background Breast cancer survivors have a unique risk for negative health outcomes. Engaging in routine physical activity (PA) can reduce these risks. However, PA levels are low among this population. Narrative visualization (NV) is a technique that uses drawings, photographs, and text to contextualize data, which may increase integrated regulation, or motivation related to personal values and identity. A PA intervention targeting breast cancer survivors using an NV strategy may improve PA behavior. The purpose of this study was to determine whether scrapbooking activities could successfully be used as an NV strategy for older (55+) breast cancer survivors. Methods Breast cancer survivors were given workbooks, wearable electronic activity monitors, instant cameras, and art supplies including a variety of stickers (e.g., emojis, affirmations). Participants were instructed to use these materials for 7 days. The workbook pages prompted participants to re-draw their daily activity graphs from the wearable’s mobile app, then annotate them with text, photographs, stickers, etc. to reflect what the data meant to them. Hybrid thematic analysis was used to analyze the photographs, drawings, and written content to identify emergent themes. Content analysis was also used to investigate use of stickers and photographs. Results Of the 20 consented women (mean age 67 ± 5 years, 45% non-Hispanic white), 3 participants were lost to follow-up or unable to complete the procedures. The NV procedures were successfully utilized by the remaining 17 participants, who collectively used 945 stickers over 7 days, most of which were emojis. Emojis were both positively and negatively valanced. Participants took a mean of 9 photos over 7 days and completed workbook questions regarding current PA and PA goals. Themes within the photos included family, specific locations, everyday objects, religion, and friends. Themes within the written portions of the workbook included family, chores and obligations, health, personal reflection, hobbies, and shopping. Conclusions The materials provided allowed breast cancer survivors to successfully use NV techniques to reflect on their PA data and behavior. These techniques show promise for promoting integrated regulation in activity monitoring interventions. Trial registration This study was funded by the National Cancer Institute (R21CA218543) beginning July 1, 2018.
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Affiliation(s)
- Jason R Bentley
- University of Texas Medical Branch, Galveston, TX, USA. .,University of Houston Clear Lake, Houston, TX, USA.
| | - Xiaoying Yu
- University of Texas Medical Branch, Galveston, TX, USA
| | | | - Brian Downer
- University of Texas Medical Branch, Galveston, TX, USA
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Robertson MC, Cox-Martin E, Shegog R, Markham CM, Fujimoto K, Durand CP, Brewster A, Lyons EJ, Liao Y, Flores SA, Basen-Engquist KM. The Acceptability of an Electronically Delivered Acceptance- and Mindfulness-Based Physical Activity Intervention for Survivors of Breast Cancer: One-Group Pretest-Posttest Design. JMIR Cancer 2022; 8:e31815. [PMID: 35486425 PMCID: PMC9107061 DOI: 10.2196/31815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 12/14/2021] [Accepted: 01/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background Survivors of breast cancer can face internal barriers to physical activity, such as uncertainty and frustration stemming from physical limitations, decreased physical functioning, fatigue, and pain. Interventions that draw from the principles of Acceptance and Commitment Therapy (ACT) may help survivors of breast cancer overcome some of the internal barriers associated with physical activity. Objective The primary aim of this study was to investigate the acceptability of an electronically delivered physical activity intervention for survivors of breast cancer, centered on ACT processes. Methods This study used a 1-group pretest-posttest design. We recruited 80 insufficiently active female survivors of breast cancer using a web-based recruitment strategy. The 8-week intervention consisted of weekly modules that featured didactic lessons and experiential exercises targeting key ACT processes in the context of physical activity promotion (namely, values, committed action, acceptance, defusion, and contacting the present moment). We determined intervention acceptability according to study retention (≥70%), adherence rates (≥75% of the participants completing ≥50% of the modules), and posttest survey scores reflecting the perceived ease of use, perceived usefulness, and interest and enjoyment of the intervention (≥5 on a 7-point Likert-type scale). We also evaluated changes in self-reported aerobic and muscle strengthening–physical activity, physical activity acceptance, physical activity regulation, and health-related outcomes. Results The retention rate (61/80, 76%), adherence rate (60/80, 75%), average perceived ease of use (6.17, SD 1.17), perceived usefulness (5.59, SD 1.40), and interest and enjoyment scores (5.43, SD 1.40) met the acceptability criteria. Participants increased their self-reported aerobic physical activity (Cohen d=1.04), muscle strengthening–physical activity (Cohen d=1.02), physical activity acceptance (cognitive acceptance: Cohen d=0.35; behavioral commitment: Cohen d=0.51), physical activity regulation (identified regulation: Cohen d=0.37; integrated regulation: Cohen d=0.66), increased their ability to participate in social roles and activities (Cohen d=0.18), and reported less fatigue (Cohen d=0.33) and sleep disturbance (Cohen d=0.53). Conclusions Electronically delivered acceptance- and mindfulness-based interventions may be useful for promoting physical activity in survivors of breast cancer. Further research is needed to refine these approaches and evaluate their effectiveness.
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Affiliation(s)
- Michael C Robertson
- Department of Nutrition, Metabolism, and Rehabilitation Sciences, The University of Texas Medical Branch, Galveston, TX, United States.,Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX, United States.,Health Promotion & Behavioral Sciences, University of Texas School of Public Health, Houston, TX, United States
| | | | - Ross Shegog
- Health Promotion & Behavioral Sciences, University of Texas School of Public Health, Houston, TX, United States
| | - Christine M Markham
- Health Promotion & Behavioral Sciences, University of Texas School of Public Health, Houston, TX, United States
| | - Kayo Fujimoto
- Health Promotion & Behavioral Sciences, University of Texas School of Public Health, Houston, TX, United States
| | - Casey P Durand
- Health Promotion & Behavioral Sciences, University of Texas School of Public Health, Houston, TX, United States
| | - Abenaa Brewster
- Department of Clinical Cancer Prevention, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Elizabeth J Lyons
- Department of Nutrition, Metabolism, and Rehabilitation Sciences, The University of Texas Medical Branch, Galveston, TX, United States
| | - Yue Liao
- College of Nursing and Health Innovation, The University of Texas, Arlington, TX, United States
| | - Sara A Flores
- Department of Health and Kinesiology, Texas A&M University, College Station, TX, United States
| | - Karen M Basen-Engquist
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX, United States
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Robertson MC, Swartz MC, Christopherson U, Bentley JR, Basen-Engquist KM, Thompson D, Volpi E, Lyons EJ. A Photography-based, Social Media Walking Intervention Targeting Autonomous Motivations for Physical Activity: Semistructured Interviews With Older Women. JMIR Serious Games 2022; 10:e35511. [PMID: 35436205 PMCID: PMC9052025 DOI: 10.2196/35511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/03/2022] [Accepted: 02/17/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Older adult women are at risk for negative health outcomes that engaging in sustained physical activity can help prevent. However, promoting long-term maintenance of physical activity in this population has proven to be a challenge. Increasing autonomous motivations (ie, intrinsic, integrated, and identified regulations) for physical activity may facilitate enduring behavior change. Digitally delivered games for health that take a celebratory technology approach, that is, using technology to create new ways to experience valued behaviors and express valued beliefs, may be a useful way to target autonomous motivations for physical activity. Formative research with the target population is needed to design compelling intervention content. OBJECTIVE The objective of this study is to investigate older adult women's reactions to and thoughts about a photography-based, social media walking game targeting autonomous motivations for physical activity. METHODS During an individual semistructured interview, a moderator solicited feedback from 20 older adult women (age range 65-74 years) as part of formative research to develop a social media game featuring weekly walking challenges. The challenges were designed to target autonomous motivations for physical activity. Interviews were audio-recorded and transcribed verbatim. Two reviewers conducted thematic content analysis on interview transcripts. RESULTS We identified 3 overarching themes in qualitative data analysis. These reflected the playful experiences, value, and acceptability associated with the intervention challenges. Generally, participants understood what the challenges were asking them to do, proffered appropriate example responses, and indicated that the challenges would be enjoyable. Participants reported that the intervention content afforded many and varied playful experiences (eg, competition, discovery, exploration, expression, fellowship, humor, nurture, sensation). Further, participants indicated that the intervention increased their motivation for physical activity, occasioned meaningful shifts in perspective, increased their knowledge of various topics of interest, provided an opportunity to create valued connection with others, and provided health-related benefits. Participants suggested the intervention emphasize local history, nature, and cultural events. CONCLUSIONS The photography-based, social media walking game with relatively simple game mechanics was well received and judged to be apt to bring about a wide variety of emotive experiences. A clear, geographically specific identity emerged as a key driver of interest for intervention content. Taking a celebratory technology approach holds promise for targeting autonomous motivations for physical activity in older adult women.
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Affiliation(s)
- Michael C Robertson
- Department of Nutrition, Metabolism & Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch at Galveston, Galveston, TX, United States
| | - Maria Chang Swartz
- Department of Pediatrics-Research, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ursela Christopherson
- Department of Nutrition, Metabolism & Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch at Galveston, Galveston, TX, United States
| | - Jason R Bentley
- Department of Nutrition, Metabolism & Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch at Galveston, Galveston, TX, United States
- Department of Clinical Health and Applied Sciences, University of Houston - Clear Lake, Houston, TX, United States
| | - Karen M Basen-Engquist
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Debbe Thompson
- US Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, United States
| | - Elena Volpi
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, United States
| | - Elizabeth J Lyons
- Department of Nutrition, Metabolism & Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch at Galveston, Galveston, TX, United States
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9
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Robertson MC, Baranowski T, Thompson D, Basen-Engquist KM, Swartz MC, Lyons EJ. Using the Behaviour Change Wheel Program Planning Model to Design Games for Health: Development Study. JMIR Serious Games 2021; 9:e29964. [PMID: 34870604 PMCID: PMC8686484 DOI: 10.2196/29964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/20/2021] [Accepted: 08/03/2021] [Indexed: 11/23/2022] Open
Abstract
Background Games for health are a promising approach to health promotion. Their success depends on achieving both experiential (game) and instrumental (health) objectives. There is little to guide game for health (G4H) designers in integrating the science of behavior change with the art of game design. Objective The aim of this study is to extend the Behaviour Change Wheel program planning model to develop Challenges for Healthy Aging: Leveraging Limits for Engaging Networked Game-Based Exercise (CHALLENGE), a G4H centered on increasing physical activity in insufficiently active older women. Methods We present and apply the G4H Mechanics, Experiences, and Change (MECHA) process, which supplements the Behaviour Change Wheel program planning model. The additional steps are centered on identifying target G4H player experiences and corresponding game mechanics to help game designers integrate design elements and G4H objectives into behavioral interventions. Results We identified a target behavior of increasing moderate-intensity walking among insufficiently active older women and key psychosocial determinants of this behavior from self-determination theory (eg, autonomy). We used MECHA to map these constructs to intervention functions (eg, persuasion) and G4H target player experiences (eg, captivation). Next, we identified behavior change techniques (eg, framing or reframing) and specific game mechanics (eg, transforming) to help realize intervention functions and elicit targeted player experiences. Conclusions MECHA can help researchers map specific linkages between distal intervention objectives and more proximal game design mechanics in games for health. This can facilitate G4H program planning, evaluation, and clearer scientific communication.
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Affiliation(s)
- Michael C Robertson
- Department of Nutrition, Metabolism & Rehabilitation Sciences, University of Texas Medical Branch at Galveston, Galveston, TX, United States
| | - Tom Baranowski
- U.S. Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, United States
| | - Debbe Thompson
- U.S. Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, United States
| | - Karen M Basen-Engquist
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Maria Chang Swartz
- Department of Pediatrics-Research, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Elizabeth J Lyons
- Department of Nutrition, Metabolism & Rehabilitation Sciences, University of Texas Medical Branch at Galveston, Galveston, TX, United States
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10
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Robertson MC, Cox-Martin E, Liao Y, Flores SA, Shegog R, Markham CM, Fujimoto K, Durand CP, Brewster A, Lyons EJ, Basen-Engquist KM. Acceptance- and mindfulness-based techniques for physical activity promotion in breast cancer survivors: a qualitative study. Support Care Cancer 2021; 30:465-473. [PMID: 34313858 PMCID: PMC8314027 DOI: 10.1007/s00520-021-06428-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/11/2021] [Indexed: 11/08/2022]
Abstract
Purpose The purpose of this study was to develop and characterize the relevance and potential utility of an electronically delivered acceptance- and mindfulness-based approaches to physical activity promotion for insufficiently active breast cancer survivors. Methods The acceptance- and mindfulness-based physical activity intervention was delivered to participants electronically over the course of 4–8 weeks. It consisted of didactic videos, experiential exercises, and workbook-type activities that targeted principles from acceptance and commitment therapy (ACT). We conducted semi-structured, in-depth interviews with participants after they completed the intervention. Three coders conducted qualitative data analysis on interview transcripts to identify overarching themes and subthemes. Results We recruited 30 participants. Of those, 16 engaged in an individual interview. The mean age of the sample was 58.4 years (SD = 13.8). The sample was relatively well educated (50.0% college graduates) and mostly overweight or obese (58.8%). We identified two overarching themes from interviews. They were centered on (1) internal and external barriers to physical activity adherence and (2) the utility of targeting core ACT processes (acceptance and defusion, mindfulness, and values clarification) for physical activity promotion. Conclusion Intervention content was perceived to be acceptable, relevant, and to fulfill important needs related to healthy living. Findings suggest that this approach to physical activity promotion can be delivered effectively online. Electronically delivered acceptance- and mindfulness-based approaches hold promise for helping insufficiently active breast cancer survivors increase physical activity.
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Affiliation(s)
- Michael C Robertson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA. .,Health Promotion & Behavioral Sciences, The University of Texas School of Public Health, 1200 Pressler Street, Houston, TX, 77030, USA. .,Division of Rehabilitation Science, The University of Texas Medical Branch At Galveston, 301 University Boulevard, Galveston, TX, 77555, USA.
| | - Emily Cox-Martin
- VA Puget Sound Health Care System, 9600 Veterans Dr SW, Tacoma, WA, USA
| | - Yue Liao
- College of Nursing and Health Innovation, The University of Texas At Arlington, 411 S Nedderman Dr, Arlington, TX, 76010, USA
| | - Sara A Flores
- Department of Health and Kinesiology, Texas A&M University, College Station, TX, 77843, USA
| | - Ross Shegog
- Health Promotion & Behavioral Sciences, The University of Texas School of Public Health, 1200 Pressler Street, Houston, TX, 77030, USA
| | - Christine M Markham
- Health Promotion & Behavioral Sciences, The University of Texas School of Public Health, 1200 Pressler Street, Houston, TX, 77030, USA
| | - Kayo Fujimoto
- Health Promotion & Behavioral Sciences, The University of Texas School of Public Health, 1200 Pressler Street, Houston, TX, 77030, USA
| | - Casey P Durand
- Health Promotion & Behavioral Sciences, The University of Texas School of Public Health, 1200 Pressler Street, Houston, TX, 77030, USA
| | - Abenaa Brewster
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Elizabeth J Lyons
- Department of Nutrition and Metabolism, Medical Branch At Galveston, The University of Texas, 301 University Boulevard, Galveston, TX, 77555, USA
| | - Karen M Basen-Engquist
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
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11
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Christopherson U, Wells SJ, Parker N, Lyons EJ, Swartz MD, Blozinski A, Basen-Engquist K, Peterson S, Swartz MC. Use of active video games with or without videoconferencing on health outcomes in adolescent and young adult cancer survivors: a systematic review. J Cancer Surviv 2021; 16:714-727. [PMID: 34086184 PMCID: PMC8175926 DOI: 10.1007/s11764-021-01065-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 05/26/2021] [Indexed: 01/20/2023]
Abstract
PURPOSE Adolescent and young adult (AYA) cancer survivors experience greater functional deficits compared to non-cancer peers or older survivors with a similar diagnosis. Physical activity (PA) is a key strategy for mitigating functional decline, and motivation and peer support are critical PA facilitators in AYA cancer survivors. Active video games (AVGs) may be a "gateway" method to promote PA. Further, integrating AVGs into group videoconferencing, a medium used by AYAs to socialize, can capitalize on peer support needed for PA motivation. Thus, we examined the use of AVGs and/or videoconferencing in PA interventions that included AYA survivors and the effect on physical function and health outcomes. METHODS Seven electronic databases were searched from incept to January 2020. Search terms included videoconferencing, video games, exercise, and cancer. The protocol is registered on PROSPERO: CRD42020163491. Two reviewers evaluated eligibility and methodological quality using Cochrane's risk of bias tools. RESULTS Six unique studies were included with 97% reviewer agreement. All used AVGs, none used videoconferencing alone, and one used both. Study designs and outcome measures were heterogeneous. Only one study solely targeted AYA survivors. Most were low to medium quality. Few showed significant improvements in quality of life (QOL) and fatigue (n=3), coordination/balance (n=2), and aerobic capacity (n=1). CONCLUSIONS PA interventions using AVGs and/or videoconferencing may improve QOL and fatigue, but evidence on function is lacking. Rigorous interventions targeting AYA survivors are needed. IMPLICATIONS FOR CANCER SURVIVORS Using AVGs and/or videoconferencing to facilitate PA may improve QOL and fatigue.
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Affiliation(s)
- Ursela Christopherson
- Division of Rehabilitation Sciences, The University of Texas Medical Branch, Galveston, TX USA
| | - Stephanie J. Wells
- Department of Pediatrics Research, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Nathan Parker
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Elizabeth J. Lyons
- Department of Nutrition and Metabolism, The University of Texas Medical Branch, Galveston, TX USA
| | - Michael D. Swartz
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston, Houston, TX USA
| | - Anna Blozinski
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston, Houston, TX USA
| | - Karen Basen-Engquist
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Susan Peterson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Maria C. Swartz
- Department of Pediatrics Research, The University of Texas MD Anderson Cancer Center, Houston, TX USA
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12
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Robertson MC, Lyons EJ, Liao Y, Baum ML, Basen-Engquist KM. Gamified Text Messaging Contingent on Device-Measured Steps: Randomized Feasibility Study of a Physical Activity Intervention for Cancer Survivors. JMIR Mhealth Uhealth 2020; 8:e18364. [PMID: 33231551 PMCID: PMC7723748 DOI: 10.2196/18364] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 08/24/2020] [Accepted: 09/15/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Physical activity can confer diverse benefits on cancer survivors. Unfortunately, many cancer survivors are not sufficiently active. The efficacy of physical activity interventions for this population may be increased by grounding them in Self-Determination Theory (SDT). Combining game design elements with wearable technologies may be a useful and scalable approach to targeting SDT constructs to promote cancer survivors' physical activity. OBJECTIVE The primary aim of this study is to evaluate the feasibility and acceptability of Steps2Health, a physical activity intervention for cancer survivors. It also aims to investigate the effects of the intervention on motivation, physical activity, and step count. METHODS We randomized 78 insufficiently active cancer survivors to an experimental or comparison group. All participants received a physical activity tracker. The experimental group participants also received a set sequence of multimedia messaging service messages that were triggered in real time by meeting predetermined cumulative step count totals. Messages presented information about a virtual journey and included photographs and vivid descriptions of locations to increase autonomous motivation. Additional messages targeted perceptions of relatedness (eg, role modeling) and competence (eg, facilitating mastery experiences). We administered pre- and postintervention surveys and conducted 15 individual interviews to evaluate the intervention. We performed directed content analysis of qualitative data and conducted mixed effects linear modeling to investigate participants' changes in motivation, self-reported physical activity, and device-measured step counts. RESULTS There was minimal loss to follow-up (3/78, 4%), the device wear rate was high (2548/3044, 83.71% of days), and technical problems with messaging based on real-time step counts were limited. Our qualitative data analysis revealed 3 overarching themes: accessibility, autonomous motivation, and relatedness. Participants successfully navigated the technological aspects and game design elements of the intervention. Participants found messages targeting autonomous motivation and competence or self-efficacy to be enjoyable and compelling, but one feasibility criterion for participant engagement (response rate to text messages) was not met. Messages targeting relatedness were less highly rated than the messages targeting autonomous motivation and competence or self-efficacy. During the intervention, both groups increased their motivation for physical activity (B=0.16; 95% CI 0.01 to 0.30; P=.04; d=0.49), and assignment to the experimental group was associated with increased self-reported leisure activity score (B=10.78; 95% CI 3.54 to 18.02; P=.005; d=0.64). The experimental group had greater increases in daily step counts over time (B=322.08; 95% CI 54.01 to 590.15; P=.02; d=0.28). CONCLUSIONS This study supports the feasibility of using real-time game design elements to target SDT constructs and increase cancer survivors' physical activity. Overall, our findings support the acceptability of the Steps2Health intervention, but fostering active participant engagement and targeting relatedness may present additional challenges. Steps2Health may help cancer survivors increase their physical activity levels.
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Affiliation(s)
- Michael C Robertson
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX, United States.,Health Promotion & Behavioral Sciences, University of Texas School of Public Health, Houston, TX, United States
| | - Elizabeth J Lyons
- Department of Nutrition and Metabolism, School of Health Professions, The University of Texas Medical Branch at Galveston, Galveston, TX, United States
| | - Yue Liao
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX, United States.,Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, United States
| | - Miranda L Baum
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Karen M Basen-Engquist
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX, United States
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13
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Lewis ZH, Ottenbacher KJ, Fisher SR, Jennings K, Brown AF, Swartz MC, Martinez E, Lyons EJ. Effect of Electronic Activity Monitors and Pedometers on Health: Results from the TAME Health Pilot Randomized Pragmatic Trial. Int J Environ Res Public Health 2020; 17:ijerph17186800. [PMID: 32961834 PMCID: PMC7559399 DOI: 10.3390/ijerph17186800] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/10/2020] [Accepted: 09/13/2020] [Indexed: 11/16/2022]
Abstract
Background: Brief counseling and self-monitoring with a pedometer are common practice within primary care for physical activity promotion. It is unknown how high-tech electronic activity monitors compare to pedometers within this setting. This study aimed to investigate the outcomes, through effect size estimation, of an electronic activity monitor-based intervention to increase physical activity and decrease cardiovascular disease risk. Method: The pilot randomized controlled trial was pre-registered online at clinicaltrials.gov (NCT02554435). Forty overweight, sedentary participants 55–74 years of age were randomized to wear a pedometer or an electronic activity monitor for 12 weeks. Physical activity was measured objectively for 7 days at baseline and follow-up by a SenseWear monitor and cardiovascular disease risk was estimated by the Framingham risk calculator. Results: Effect sizes for behavioral and health outcomes ranged from small to medium. While these effect sizes were favorable to the intervention group for physical activity (PA) (d = 0.78) and general health (d = 0.39), they were not favorable for measures. Conclusion: The results of this pilot trial show promise for this low-intensity intervention strategy, but large-scale trials are needed to test its efficacy.
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Affiliation(s)
- Zakkoyya H. Lewis
- College of Science, Department of Kinesiology and Health Promotion, California State Polytechnic University Pomona, 3801 West Temple Ave., Pomona, CA 91768, USA
- Correspondence:
| | - Kenneth J. Ottenbacher
- School of Health Professions, Division of Rehabilitation Sciences, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA;
| | - Steve R. Fisher
- School of Health Professions, Department of Physical Therapy, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA;
| | - Kristofer Jennings
- Department of Biostatistics, MD Anderson Cancer Center, 1400 Pressler St., Unit 1411, Houston, TX 77030-4008, USA;
| | - Arleen F. Brown
- School of Medicine, Division of General Internal Medicine and Health Services Research, University of California Los Angeles, 1100 Glendon, Ave., Los Angeles, CA 90095, USA;
| | - Maria C. Swartz
- Department of Pediatrics, Division of Pediatrics, MD Anderson Cancer Center, 7777 Knight Rd., Houston, TX 77054, USA;
| | - Eloisa Martinez
- Sealy Center on Aging, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA;
| | - Elizabeth J. Lyons
- School of Health Professions, Department of Nutrition and Metabolism, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, USA;
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14
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Tzeng HM, Okpalauwaekwe U, Lyons EJ. Barriers and Facilitators to Older Adults Participating in Fall-Prevention Strategies After Transitioning Home from Acute Hospitalization: A Scoping Review. Clin Interv Aging 2020; 15:971-989. [PMID: 32612356 PMCID: PMC7323788 DOI: 10.2147/cia.s256599] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/10/2020] [Indexed: 01/11/2023] Open
Abstract
Purpose Approximately, 14% of older adults aged 65 years and over experience a fall within 1 month post-hospital discharge. Adequate self-management may minimize the impact of these falls; however, research is lacking on why some older adults engage in self-management to prevent falls while others do not. Methods We conducted a scoping review to identify barriers and facilitators to older adults participating in fall-prevention strategies after transitioning home from acute hospitalization. Eligibility criteria were peer-reviewed journal articles published during 2009-2019 which were written in English and contained any of the following keywords or their synonyms: "fall-prevention," "older adults," "post-discharge" and "transition care." We systematically and selectively summarized the findings of these articles using the Joanna Briggs Institute guidelines and the PRISMA-ScR reporting guidelines. Seven bibliographic databases were searched: PubMed/MEDLINE, ERIC, CINAHL, Cochrane Library, Scopus, PsycINFO, and Web of Science. We used the Capability-Opportunity-Motivation-Behavior (COM-B) model of health behavior change as a framework to guide the content, thematic analysis, and descriptive results. Results Seventeen articles were finally selected. The most frequently mentioned barriers and facilitators for each COM-B dimension differed. Motivation factors include such as older adults lacking inner drive and self-denial of being at risk for falls (barriers) and following-up with older adults and correcting inaccurate perceptions of falls and fall-prevention strategies (facilitators). Conclusion This scoping review revealed gaps and future research areas in fall prevention relative to behavioral changes. These findings may enable tailoring feasible fall-prevention interventions for older adults after transitioning home from acute hospitalization.
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Affiliation(s)
- Huey-Ming Tzeng
- The University of Texas Medical Branch, School of Nursing, Galveston, TX, USA
| | - Udoka Okpalauwaekwe
- University of Saskatchewan, College of Medicine, Saskatoon, Saskatchewan S7N 2Z4, Canada
| | - Elizabeth J Lyons
- University of Texas Medical Branch, Department of Nutrition and Metabolism, School of Health Professions, Galveston, TX, USA
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15
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Swartz MC, Chou LN, Swartz MD, Lyons EJ, Mehta H, Karmarkar A, Middleton A, Basen-Engquist K, Giordano SH, Goodwin J. A Retrospective Study of Administrative Data to Identify Factors Associated with Future Disability Status among Older Colorectal Cancer Survivors. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1055-9965.epi-20-0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Disability is associated with loss of independence and early mortality. Currently, only 1–2% of cancer survivors who reported physical limitations received rehabilitation services. It is critical to identify factors associated with the development of disability to guide clinical practice given treatment changes. We aimed to 1) identify demographic and cancer-related characteristics associated with future disability status among older colorectal cancer survivors, and 2) compared the future disability status among cancer and matched non-cancer cohorts. Methods: We conducted a retrospective cohort study using the Texas Cancer Registry-national Medicare linked database. The cancer cohort included Medicare beneficiaries with a primary colorectal cancer diagnosis between 2005 and 2013 (n = 13,229). The non-cancer cohort was identified from a 5% sample of Medicare beneficiaries (n = 11,416). Diagnosis dates from the cancer cohort were used as the index date for the non-cancer cohort. Cohorts were matched 1:1 based on index date, age, and gender. Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals. Disability status was defined according to Davidoff and colleagues using inpatient, outpatient and durable medical equipment claims files, and assessed monthly, beginning 1 month after cancer diagnosis (or index date), continuing until disability, death, end of Medicare continuous enrollment, or end of study. Results: Factors that were significantly associated with disability status in the cancer cohort were age (HR = 3.50 for >80 years old), female gender (HR = 1.50), race/ethnicity (HR = 1.34 for Hispanic and 1.21 for Black), stage (HR = 2.26 for distant stage), comorbidity (HR = 2.18 for >1), and radiation (HR = 1.21). When compared to the non-cancer cohort, having a cancer diagnosis (HR = 1.07) and comorbidity (HR = 2.09 for >1) were associated with developing disability. Conclusions: Colorectal diagnosis is an independent risk for disability status. Beyond well-known risk factors “age and mortality” subsets of survivors (Hispanic and Black survivors and those with comorbidity) are found to be at higher risk for developing disability. This warrants further investigation and may indicate targeted intervention to prevent future disability.
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16
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Swartz MC, Allen K, Deer RR, Lyons EJ, Swartz MD, Clifford T. A Narrative Review on the Potential of Red Beetroot as an Adjuvant Strategy to Counter Fatigue in Children with Cancer. Nutrients 2019; 11:E3003. [PMID: 31817919 PMCID: PMC6949985 DOI: 10.3390/nu11123003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/04/2019] [Accepted: 12/06/2019] [Indexed: 01/04/2023] Open
Abstract
Cancer-related fatigue (CRF) is a debilitating adverse effect among children with cancer and a significant barrier to physical activity (PA) participation. PA interventions are effective at reducing fatigue and improving both quality of life (QOL) and functional outcomes in children with cancer. However, 50-70% of children with cancer do not meet PA guidelines. Thus, adjuvant methods are needed to increase PA participation. Given the growing interest in the use of beetroot juice to reduce exercise-induced fatigue, our narrative review evaluated the potential use of beetroot to improve PA participation to counter CRF and improve QOL. Our review of 249 articles showed a lack of published clinical trials of beetroot in children and adults with cancer. Trials of beetroot use had been conducted in a noncancer population (n = 198), and anticancer studies were primarily in the preclinical phase (n = 40). Although results are promising, with beetroot juice shown to counter exercise-induced fatigue in a variety of athletic and patient populations, its use to counter CRF in children with cancer is inconclusive. Pilot and feasibility studies are needed to examine the potential benefits of beetroot to counter CRF, increase PA participation, and improve QOL in children with cancer.
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Affiliation(s)
- Maria C. Swartz
- Department of Pediatrics-Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030-4009, USA
| | - Kaitlyn Allen
- Department of Nutrition and Metabolism, The University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-1124, USA; (K.A.); (E.J.L.)
| | - Rachel R. Deer
- Division of Rehabilitation Sciences, The University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-1137, USA;
| | - Elizabeth J. Lyons
- Department of Nutrition and Metabolism, The University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-1124, USA; (K.A.); (E.J.L.)
| | - Michael D. Swartz
- Department of Biostatistics and Data Science, The University of Texas Health Science Center, School of Public Health, 1200 Pressler St., Houston, TX 77030, USA;
| | - Tom Clifford
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire LE11 3TU, UK;
- School of Biomedical, Nutritional and Sport Sciences, Newcastle University, Newcastle NE2 4HH, UK
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17
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Baranowski T, Lyons EJ, Thompson D. Experimental Design to Systematically Develop a Knowledge Base for Effective Games for Health. Games Health J 2019; 8:307-312. [DOI: 10.1089/g4h.2019.0057] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Tom Baranowski
- Department of Pediatrics, USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas
| | - Elizabeth J. Lyons
- Department of Nutrition and Metabolism, The University of Texas Medical Branch, Galveston, Texas
| | - Debbe Thompson
- Department of Pediatrics, USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas
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18
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Lewis ZH, Swartz MC, Martinez E, Lyons EJ. Social Support Patterns of Middle-Aged and Older Adults Within a Physical Activity App: Secondary Mixed Method Analysis. JMIR Aging 2019; 2:e12496. [PMID: 31518281 PMCID: PMC6744818 DOI: 10.2196/12496] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 05/27/2019] [Accepted: 06/18/2019] [Indexed: 01/26/2023] Open
Abstract
Background Physical activity (PA) is critical for maintaining independence and delaying mobility disability in aging adults. However, 27 to 44% of older adults in the United States are meeting the recommended PA level. Activity trackers are proving to be a promising tool to promote PA adherence through activity tracking and enhanced social interaction features. Although social support has been known to be an influential behavior change technique to promote PA, how middle-aged and older adults use the social interaction feature of mobile apps to provide virtual support to promote PA engagement remains mostly underexplored. Objective This study aimed to describe the social support patterns of middle-aged and older adults using a mobile app as part of a behavioral PA intervention. Methods Data from 35 participants (mean age 61.66 [SD 6] years) in a 12-week, home-based activity intervention were used for this secondary mixed method analysis. Participants were provided with a Jawbone Up24 activity monitor and an Apple iPad Mini installed with the UP app to facilitate self-monitoring and social interaction. All participants were given an anonymous account and encouraged to interact with other participants using the app. Social support features included comments and likes. Thematic coding was used to identify the type of social support provided within the UP app and characterize the levels of engagement from users. Participants were categorized as superusers or contributors, and passive participants were categorized as lurkers based on the literature. Results Over the 12-week intervention, participants provided a total of 3153 likes and 1759 comments. Most participants (n=25) were contributors, with 4 categorized as superusers and 6 categorized as lurkers. Comments were coded as emotional support, informational support, instrumental support, self-talk, and other, with emotional support being the most prevalent type. Conclusions Our cohort of middle-aged and older adults was willing to use the social network feature in an activity app to communicate with anonymous peers. Most of our participants were contributors. In addition, the social support provided through the activity app followed social support constructs. In sum, PA apps are a promising tool for delivering virtual social support to enhance PA engagement and have the potential to make a widespread impact on PA promotion. Trial Registration ClinicalTrials.gov NCT01869348; https://clinicaltrials.gov/ct2/show/NCT01869348
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Affiliation(s)
- Zakkoyya H Lewis
- Kinesiology & Health Promotion Department, California State Polytechnic University Pomona, Pomona, CA, United States
| | - Maria C Swartz
- Department of Pediatrics-Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Eloisa Martinez
- Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX, United States
| | - Elizabeth J Lyons
- Department of Nutrition and Metabolism, The University of Texas Medical Branch, Galveston, TX, United States
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Abstract
Pokémon Go™ (PG) is a mobile videogame that requires real-world walking to "catch" augmented reality (AR) virtual creatures. Media attention speculated that extensive physical activity (PA) could result from PG play, which could have public health benefit. Little is known about contextual factors related to PG play and how they may impact play initiation or duration. A systematic search of articles reporting the words PG was conducted with PubMed and Google Scholar. To understand the many possible influences on and outcomes of PG play, a scoping review was conducted by employing a conceptual model to organize the literature. Although large numbers of people started playing PG, these were a relatively small proportion of the relevant populations, but PG may have activated some of those most in need of PA. Diverse factors predicted who initiated PG play, but they tended to emphasize anticipated fun, escapism, nostalgia, social ties, and desire for PA. Environmental factors (e.g., unavailable GPS signals, trespassing laws) limited PG play for some. Diverse factors predicted duration of gameplay, but fun appeared to be prominent. The level of increases in PA from PG among youth and young adults appeared to be small or undetected, and of a relatively short duration (<2 months). Among older adults, however, there were modest increases in PA for up to 7 months post-release. This intensity and duration of increased PA appears to be inadequate to stem the epidemic of obesity but may have mental and social health benefits. Although many adverse outcomes from playing PG were reported, these appear to be low incidence, which should primarily influence PG players to knowingly exercise caution. Many research issues were identified to specify who might play AR games and effective strategies to enhance game design to increase PA.
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Affiliation(s)
- Tom Baranowski
- Department of Pediatrics, USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas
| | - Elizabeth J Lyons
- The University of Texas Medical Branch, Institute for Translational Sciences, Galveston, Texas
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Bentley JR, Lewis-Trammell ZH, Swartz MC, Lyons EJ. Acceptability of a Walking Intervention Among Inactive Adults Using a Smartphone-Based Gaming Application. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000561022.49408.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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21
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Robertson MC, Lyons EJ, Song J, Cox-Martin M, Li Y, Green CE, Pinto BM, Carmack CL, Harrison C, Baum G, Basen-Engquist KM. Change in physical activity and quality of life in endometrial cancer survivors receiving a physical activity intervention. Health Qual Life Outcomes 2019; 17:91. [PMID: 31133040 PMCID: PMC6537149 DOI: 10.1186/s12955-019-1154-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 05/07/2019] [Indexed: 11/23/2022] Open
Abstract
Background Endometrial cancer survivors are at an increased risk of poor quality of life outcomes. Physical activity is positively associated with general quality of life in this population, however, little is known about how changes in physical activity may be associated with changes in specific aspects of quality of life. The aim of this secondary data analysis was to explore the relationships between change in physical activity and change in physical, mental, social, and other aspects of quality of life in endometrial cancer survivors receiving a physical activity intervention. Methods Endometrial cancer survivors (N = 100) participated in a telephone-based physical activity intervention for six months. At baseline and post-intervention we measured physical activity via accelerometry and ecological momentary assessment, and quality of life via the Short Form Health Survey (SF-36), the Quality of Life of Adult Cancer Survivors instrument, the Brief Symptom Inventory, the Pittsburgh Sleep Quality Index, and the Perceived Stress Scale. We conducted structural equation modeling path analyses to investigate how physical activity post-intervention was associated with the quality of life measures’ subscales post-intervention, adjusting for baseline levels and potentially confounding covariates. Results Increasing physical activity was positively associated with improvements in general health (p = .044), role limitation due to physical health (p = .005), pain (p = .041), and somatic distress (p = .023). There was no evidence to indicate that change in physical activity was associated with change in other aspects of quality of life. Conclusions Endometrial cancer survivors are at higher risk for suffering from challenges to physical quality of life, and findings from this study suggest that increasing physical activity may alleviate some of these problems. Further research is needed to determine whether other aspects of quality of life are linked to change in physical activity. Trial registration Trial registration number: NCT00501761 Name of registry: clinicaltrials.gov Date of registration: July 16, 2007. Date of enrollment: June 16, 2005.
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Affiliation(s)
- Michael C Robertson
- Center for Energy Balance, Department of Behavioral Science, MD Anderson Cancer Center, Cancer Prevention Building, Unit 1330, 1155 Pressler St, Houston, TX, 77030, USA.,Health Promotion & Behavioral Sciences, University of Texas School of Public Health, 1200 Pressler Street, Houston, TX, 77030, USA
| | - Elizabeth J Lyons
- Department of Nutrition and Metabolism, School of Health Professions, University of Texas Medical Branch at Galveston, 301 University Boulevard, Galveston, TX, 77555-1124, USA
| | - Jaejoon Song
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Houston, TX, 77030, USA
| | - Matthew Cox-Martin
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado at Denver-Anschutz Medical Campus, Aurora, CO, USA
| | - Yisheng Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Pickens Academic Tower, 1400 Pressler St, Houston, TX, 77030, USA
| | - Charles E Green
- Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center, 6431 Fannin St, Houston, TX, 77030, USA
| | - Bernardine M Pinto
- College of Nursing, University of South Carolina, 1601 Greene Street, Room 302B, Columbia, SC, 29208-4001, USA
| | - Cindy L Carmack
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, MD Anderson Cancer Center, Cancer Prevention Building, Unit 1330, 1155 Pressler St, Houston, TX, 77030, USA
| | - Carol Harrison
- Center for Energy Balance, Department of Behavioral Science, MD Anderson Cancer Center, Cancer Prevention Building, Unit 1330, 1155 Pressler St, Houston, TX, 77030, USA
| | - George Baum
- Center for Energy Balance, Department of Behavioral Science, MD Anderson Cancer Center, Cancer Prevention Building, Unit 1330, 1155 Pressler St, Houston, TX, 77030, USA
| | - Karen M Basen-Engquist
- Center for Energy Balance, Department of Behavioral Science, MD Anderson Cancer Center, Cancer Prevention Building, Unit 1330, 1155 Pressler St, Houston, TX, 77030, USA.
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22
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Robertson MC, Liao Y, Song J, Lyons EJ, Basen-Engquist KM. Motivation for physical activity and the moderating effect of cancer diagnosis: A nationally representative cross-sectional study. Prev Med 2018; 115:8-11. [PMID: 30081132 PMCID: PMC8170853 DOI: 10.1016/j.ypmed.2018.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/15/2018] [Accepted: 08/02/2018] [Indexed: 11/24/2022]
Abstract
The aim of this study was to investigate associations between types of motivation for physical activity and self-reported weekly aerobic moderate-to-vigorous physical activity (MVPA) in the 2012 and 2014 waves of the nationally representative Health Information National Trends Survey 4 (n = 7307). We further explored differential associations between MVPA and types of motivation for physical activity by cancer survivor status. We found that those who were more motivated by "getting enjoyment from exercise" reported 26.4% more MVPA (+49.8 min/week) than those who were less motivated by this factor, adjusting for covariates (p = 0.025). Conversely, those who were more motivated by "concern over the way you look" reported 22.1% less MVPA (-55.5 min/week) than those who were less motivated by this factor, adjusting for covariates (p = 0.002). We found no evidence for a relationship between motivation from either "pressure from others" or "feeling guilty when you skip exercising" and MVPA. We identified a significant interaction for "feeling guilty when you skip exercising" and cancer survivor status, adjusting for covariates (p = 0.034). Cancer survivors who reported being more motivated by "feeling guilty when you skip exercising" reported 36.2% less MVPA (-71.75 min/week) than those who were less motivated by this factor; there was no statistically reliable difference in those without a history of cancer. Findings are concordant with previous literature highlighting the primacy of enjoyment for physical activity adherence. There is a need for further inquiry into guilt-related motivation for physical activity among cancer survivors, as it may have a unique, negative impact in this population.
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Affiliation(s)
- M C Robertson
- Center for Energy Balance, Department of Behavioral Science, MD Anderson Cancer Center, Cancer Prevention Building, Unit 1330, 1155 Pressler St, Houston, TX 77030, United States of America; Health Promotion & Behavioral Sciences, University of Texas School of Public Health, 1200 Pressler Street, Houston, TX 77030, United States of America.
| | - Y Liao
- Center for Energy Balance, Department of Behavioral Science, MD Anderson Cancer Center, Cancer Prevention Building, Unit 1330, 1155 Pressler St, Houston, TX 77030, United States of America.
| | - J Song
- Center for Energy Balance, Department of Behavioral Science, MD Anderson Cancer Center, Cancer Prevention Building, Unit 1330, 1155 Pressler St, Houston, TX 77030, United States of America.
| | - E J Lyons
- Department of Nutrition and Metabolism, School of Health Professions, University of Texas Medical Branch at Galveston, 301 University Boulevard, Galveston, TX 77555-1124, United States of America.
| | - K M Basen-Engquist
- Center for Energy Balance, Department of Behavioral Science, MD Anderson Cancer Center, Cancer Prevention Building, Unit 1330, 1155 Pressler St, Houston, TX 77030, United States of America.
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Cox-Martin E, Song J, Demark-Wahnefried W, Lyons EJ, Basen-Engquist K. Predictors of enrollment in individual- and couple-based lifestyle intervention trials for cancer survivors. Support Care Cancer 2018; 26:2387-2395. [PMID: 29423679 DOI: 10.1007/s00520-018-4084-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 01/29/2018] [Indexed: 01/14/2023]
Abstract
PURPOSE To utilize data from lifestyle intervention pilot studies for cancer survivors to elucidate demographic, disease-related, and health behavior factors that might predict enrollment in this type of research. Additionally, factors were differentially compared based on intervention design (i.e., individual versus couple-based). METHODS Secondary data analysis was conducted regarding predictors of enrollment into lifestyle intervention studies, including Healthy Moves Weight Loss (individual participants, screened n = 89, enrolled n = 30) and Healthy Moves Couples (survivors and their partners, screened n = 197, enrolled n = 23). Due to small sample sizes, common in pilot studies, random forest analyses were used to maximize information yielded by the data. RESULTS Results identified numerous important predictors of enrollment in individual and couple-based lifestyle interventions. Percent energy from fat and physical activity minutes were identified as important predictors for both recruitment methods. Age, cancer site, and marital status were important predictors of enrollment in the individual-based intervention. Weight, fiber consumption, and disease-related symptom severity and interference were important predictors of enrollment in the couple-based intervention. CONCLUSION Although there was some overlap in predictors for enrollment between studies, many differential predictors were identified between individual versus couple-based study designs for lifestyle intervention in cancer survivors. Future lifestyle intervention studies for cancer survivors may benefit from targeting different predictors of enrollment based on study design to optimize recruitment. Additionally, understanding predictors may allow certain barriers to enrollment (i.e., symptom burden) to be directly addressed, making lifestyle intervention research more feasible and acceptable to difficult-to-recruit survivors.
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Affiliation(s)
- Emily Cox-Martin
- Division of Medical Oncology, School of Medicine, University of Colorado Anschutz Medical Campus, 12801 E 17th Ave, Aurora, CO, 80045, USA.
| | - Jaejoon Song
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, P.O. Box 301402, Houston, TX, 77230-1402, USA
| | - Wendy Demark-Wahnefried
- Department of Nutrition Sciences, University of Alabama at Birmingham, 1675 University Blvd, Birmingham, AL, 35233, USA
| | - Elizabeth J Lyons
- Department of Nutrition and Metabolism, The University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555-1124, USA
| | - Karen Basen-Engquist
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Unit 1330, P.O. Box 301439, Houston, TX, 77230-1439, USA
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24
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Prochaska JJ, Coughlin SS, Lyons EJ. Social Media and Mobile Technology for Cancer Prevention and Treatment. Am Soc Clin Oncol Educ Book 2017. [PMID: 28561647 DOI: 10.14694/edbk_173841] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Given the number of lives affected by cancer and the great potential for optimizing well-being via lifestyle changes, patients, providers, health care systems, advocacy groups, and entrepreneurs are looking to digital solutions to enhance patient care and broaden prevention efforts. Thousands of health-oriented mobile websites and apps have been developed, with a majority focused upon lifestyle behaviors (e.g., exercise, diet, smoking). In this review, we consider the use and potential of social media and mHealth technologies for cancer prevention, cancer treatment, and survivorship. We identify key principles in research and practice, summarize prior reviews, and highlight notable case studies and patient resources. Further, with the potential for scaled delivery and broad reach, we consider application of social media and mHealth technologies in low-resource settings. With clear advantages for reach, social media and mHealth technologies offer the ability to scale and engage entire populations at low cost, develop supportive social networks, connect patients and providers, encourage adherence with cancer care, and collect vast quantities of data for advancing cancer research. Development efforts have been rapid and numerous, yet evaluation of intervention effects on behavior change and health outcomes are sorely needed, and regulation around data security issues is notably lacking. Attention to broader audiences is also needed, with targeted development for culturally diverse groups and non-English speakers. Further investment in research to build the evidence base and identify best practices will help delineate and actualize the potential of social media and mHealth technologies for cancer prevention and treatment.
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Affiliation(s)
- Judith J Prochaska
- From the Department of Medicine, Stanford Prevention Research Center, Stanford University, Stanford, CA; Department of Clinical and Digital Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA; Department of Nutrition and Metabolism, The University of Texas Medical Branch, Galveston, TX
| | - Steven S Coughlin
- From the Department of Medicine, Stanford Prevention Research Center, Stanford University, Stanford, CA; Department of Clinical and Digital Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA; Department of Nutrition and Metabolism, The University of Texas Medical Branch, Galveston, TX
| | - Elizabeth J Lyons
- From the Department of Medicine, Stanford Prevention Research Center, Stanford University, Stanford, CA; Department of Clinical and Digital Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA; Department of Nutrition and Metabolism, The University of Texas Medical Branch, Galveston, TX
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25
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Swartz MC, Lewis ZH, Swartz MD, Martinez E, Lyons EJ. Brief Report: Active Ingredients for Adherence to a Tracker-Based Physical Activity Intervention in Older Adults. J Appl Gerontol 2017; 38:1023-1034. [PMID: 29165029 DOI: 10.1177/0733464817739350] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To identify factors associated with weekly adherence to a 12-week tracker-based activity intervention in older adults. METHOD Using generalized linear mixed models in a secondary analysis ( N = 35), we examined factors associated with weekly adherence (defined as wore the Jawbone Up24 tracker for ≥5 days and completed weekly calls). Factors examined included individual characteristics, gave and received virtual support, achieved step goals, barrier and task self-efficacy, and self-comment. RESULTS Participants' ( Mage = 61.7, SDage = 5.7) adherence changed from 86% (Week 1) to 74% (Week 12). Achieved the previous week's goal (β = 1.13, p = .01) and received virtual support (β = 0.01, p = .02) significantly increased the odds of weekly adherence. DISCUSSION Achieved step goals and received virtual support were associated with improved adherence to our tracker-based activity intervention, which has promising potential to be translated into the clinical setting to promote active lifestyles.
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Affiliation(s)
- Maria C Swartz
- 1 The University of Texas Medical Branch, Galveston, USA
| | - Zakkoyya H Lewis
- 1 The University of Texas Medical Branch, Galveston, USA.,2 Beachbody LLC, Santa Monica, CA, USA
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27
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Tsai E, Robertson MC, Lyons EJ, Swartz MC, Basen-Engquist K. Physical activity and exercise self-regulation in cancer survivors: A qualitative study. Psychooncology 2017; 27:563-568. [PMID: 28763133 DOI: 10.1002/pon.4519] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 06/12/2017] [Accepted: 07/26/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Despite the benefits of physical activity, many cancer survivors do not adhere to clinically recommended levels. This qualitative study investigated factors of self-regulation contributing to survivor physical activity patterns. METHODS Participants attended focus groups with prompts on exercise habits and self-regulation on the basis of social cognitive theory, self-determination theory, and self-regulation theory. Content analysis with a priori codes was conducted to identify emergent themes. RESULTS Participants (n = 35) were predominately older (63.7 y ± 10.8), female (69%), white (71%), and breast cancer (60%) survivors, with 41% not meeting activity guidelines. Emergent themes included exercise goal development, selection, and attainment; exercise planning; and self-reward. Participants tended to develop values-based, general goals rather than action-based, measurable goals. Goal attainment success emerged as a facilitator of future goal performance; completing a current goal facilitated subsequent goal attainment, while failure hindered future goal completion. Rather than having deliberate intentions to schedule exercise, participants exercised if expedient in the context of normal daily activities. Food consumption emerged as a major mechanism for self-reward. CONCLUSIONS Our findings suggest that values-based goals, unplanned activity, influence from previous goal attempts, and self-reward were important factors related to self-regulation. Interventions designed to improve self-regulation may consider facilitating development of autonomous, value-based goals, assisting in development of strategies for future goals if current goals are not met, endorsing exercise as a scheduled activity, and introducing healthy self-reward alternatives.
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Affiliation(s)
- Edward Tsai
- Department of Health Promotion and Behavioral Sciences, University of Texas School of Public Health, Houston, TX, USA.,Center for Energy Balance in Cancer Prevention and Survivorship, Department of Behavioral Sciences, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael C Robertson
- Department of Health Promotion and Behavioral Sciences, University of Texas School of Public Health, Houston, TX, USA.,Center for Energy Balance in Cancer Prevention and Survivorship, Department of Behavioral Sciences, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elizabeth J Lyons
- Department of Nutrition and Metabolism, University of Texas Medical Branch, Galveston, TX, USA
| | - Maria C Swartz
- Division of Rehabilitation Sciences Center for Recovery, Physical Activity, and Nutrition, University of Texas Medical Branch, Galveston, TX, USA
| | - Karen Basen-Engquist
- Center for Energy Balance in Cancer Prevention and Survivorship, Department of Behavioral Sciences, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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28
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Nowakowski S, Grandner MA, Stout-Aguilar J, Meers JM, Lewis-Powell Z, Swartz MC, Choi H, Lyons EJ. 0762 ACCURACY OF CONSUMER MONITORS FOR MEASURING SLEEP ACROSS SEVEN NIGHTS. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Swartz MC, Lewis ZH, Lyons EJ, Jennings K, Middleton A, Deer RR, Arnold D, Dresser K, Ottenbacher KJ, Goodwin JS. Effect of Home- and Community-Based Physical Activity Interventions on Physical Function Among Cancer Survivors: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil 2017; 98:1652-1665. [PMID: 28427925 DOI: 10.1016/j.apmr.2017.03.017] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 01/11/2017] [Accepted: 03/18/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To examine the effect of home- and community-based physical activity interventions on physical functioning among cancer survivors based on the most prevalent physical function measures, randomized trials were reviewed. DATA SOURCES Five electronic databases-Medline Ovid, PubMed, CINAHL, Web of Science, and PsycINFO-were searched from inception to March 2016 for relevant articles. STUDY SELECTION Search terms included community-based interventions, physical functioning, and cancer survivors. A reference librarian trained in systematic reviews conducted the final search. DATA EXTRACTION Four reviewers evaluated eligibility and 2 reviewers evaluated methodological quality. Data were abstracted from studies that used the most prevalent physical function measurement tools-Medical Outcomes Study 36-Item Short-Form Health Survey, Late-Life Function and Disability Instrument, European Organisation for the Research and Treatment of Cancer Quality-of-Life Questionnaire, and 6-minute walk test. Random- or fixed-effects models were conducted to obtain overall effect size per physical function measure. DATA SYNTHESIS Fourteen studies met inclusion criteria and were used to compute standardized mean differences using the inverse variance statistical method. The median sample size was 83 participants. Most of the studies (n=7) were conducted among breast cancer survivors. The interventions produced short-term positive effects on physical functioning, with overall effect sizes ranging from small (.17; 95% confidence interval [CI], .07-.27) to medium (.45; 95% CI, .23-.67). Community-based interventions that met in groups and used behavioral change strategies produced the largest effect sizes. CONCLUSIONS Home and community-based physical activity interventions may be a potential tool to combat functional deterioration among aging cancer survivors. More studies are needed among other cancer types using clinically relevant objective functional measures (eg, gait speed) to accelerate translation into the community and clinical practice.
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Affiliation(s)
- Maria C Swartz
- Division of Rehabilitation Sciences, The University of Texas Medical Branch, Galveston, TX.
| | - Zakkoyya H Lewis
- Division of Rehabilitation Sciences, The University of Texas Medical Branch, Galveston, TX; Fitness & Nutrition Results, Beachbody, Santa Monica, CA
| | - Elizabeth J Lyons
- Department of Nutrition and Metabolism, The University of Texas Medical Branch, Galveston, TX
| | - Kristofer Jennings
- Department of Preventive Medicine and Community Health, The University of Texas Medical Branch, Galveston, TX
| | - Addie Middleton
- Division of Rehabilitation Sciences, The University of Texas Medical Branch, Galveston, TX
| | - Rachel R Deer
- Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX
| | - Demi Arnold
- Department of Nutrition and Metabolism, The University of Texas Medical Branch, Galveston, TX
| | - Kaitlin Dresser
- Department of Nutrition and Metabolism, The University of Texas Medical Branch, Galveston, TX
| | - Kenneth J Ottenbacher
- Division of Rehabilitation Sciences, The University of Texas Medical Branch, Galveston, TX
| | - James S Goodwin
- Division of Geriatric Medicine, The University of Texas Medical Branch, Galveston, TX
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Lyons EJ, Swartz MC, Lewis ZH, Martinez E, Jennings K. Feasibility and Acceptability of a Wearable Technology Physical Activity Intervention With Telephone Counseling for Mid-Aged and Older Adults: A Randomized Controlled Pilot Trial. JMIR Mhealth Uhealth 2017; 5:e28. [PMID: 28264796 PMCID: PMC5359416 DOI: 10.2196/mhealth.6967] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/20/2017] [Accepted: 01/31/2017] [Indexed: 12/31/2022] Open
Abstract
Background As adults age, their physical activity decreases and sedentary behavior increases, leading to increased risk of negative health outcomes. Wearable electronic activity monitors have shown promise for delivering effective behavior change techniques. However, little is known about the feasibility and acceptability of non-Fitbit wearables (Fitbit, Inc, San Francisco, California) combined with telephone counseling among adults aged more than 55 years. Objective The purpose of our study was to determine the feasibility, acceptability, and effect on physical activity of an intervention combining a wearable physical activity monitor, tablet device, and telephone counseling among adults aged 55-79 years. Methods Adults (N=40, aged 55-79 years, body mass index=25-35, <60 min of activity per week) were randomized to receive a 12-week intervention or to a wait list control. Intervention participants received a Jawbone Up24 monitor, a tablet with the Jawbone Up app installed, and brief weekly telephone counseling. Participants set daily and weekly step goals and used the monitor’s idle alert to notify them when they were sedentary for more than 1 h. Interventionists provided brief counseling once per week by telephone. Feasibility was measured using observation and study records, and acceptability was measured by self-report using validated items. Physical activity and sedentary time were measured using ActivPAL monitors following standard protocols. Body composition was measured using dual-energy x-ray absorptiometry scans, and fitness was measured using a 6-min walk test. Results Participants were 61.48 years old (SD 5.60), 85% (34/40) female, 65% (26/40) white. Average activity monitor wear time was 81.85 (SD 3.73) of 90 days. Of the 20 Up24 monitors, 5 were reported broken and 1 lost. No related adverse events were reported. Acceptability items were rated at least 4 on a scale of 1-5. Effect sizes for most outcomes were small, including stepping time per day (d=0.35), steps per day (d=0.26), sitting time per day (d=0.21), body fat (d=0.17), and weight (d=0.33). Conclusions The intervention was feasible and acceptable in this population. Effect sizes were similar to the sizes found using other wearable electronic activity monitors, indicating that when combined with telephone counseling, wearable activity monitors are a potentially effective tool for increasing physical activity and decreasing sedentary behavior. Trial registration Clinicaltrials.gov NCT01869348; https://clinicaltrials.gov/ct2/show/NCT01869348 (Archived by WebCite at http://www.webcitation.org/6odlIolqy)
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Affiliation(s)
- Elizabeth J Lyons
- Department of Nutrition and Metabolism, The University of Texas Medical Branch, Galveston, TX, United States.,Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX, United States.,Division of Rehabilitation Sciences, The University of Texas Medical Branch, Galveston, TX, United States
| | - Maria C Swartz
- Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX, United States.,Division of Rehabilitation Sciences, The University of Texas Medical Branch, Galveston, TX, United States
| | - Zakkoyya H Lewis
- Division of Rehabilitation Sciences, The University of Texas Medical Branch, Galveston, TX, United States.,BeachBody, LLC, Santa Monica, CA, United States
| | - Eloisa Martinez
- Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX, United States
| | - Kristofer Jennings
- Department of Preventive Medicine and Community Health, The University of Texas Medical Branch, Galveston, TX, United States
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Robertson MC, Tsai E, Lyons EJ, Srinivasan S, Swartz MC, Baum ML, Basen-Engquist KM. Mobile Health Physical Activity Intervention Preferences in Cancer Survivors: A Qualitative Study. JMIR Mhealth Uhealth 2017; 5:e3. [PMID: 28119278 PMCID: PMC5296620 DOI: 10.2196/mhealth.6970] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 12/15/2016] [Accepted: 12/17/2016] [Indexed: 12/15/2022] Open
Abstract
Background Cancer survivors are at an elevated risk for several negative health outcomes, but physical activity (PA) can decrease those risks. Unfortunately, adherence to PA recommendations among survivors is low. Fitness mobile apps have been shown to facilitate the adoption of PA in the general population, but there are limited apps specifically designed for cancer survivors. This population has unique needs and barriers to PA, and most existing PA apps do not address these issues. Moreover, incorporating user preferences has been identified as an important priority for technology-based PA interventions, but at present there is limited literature that serves to establish these preferences in cancer survivors. This is especially problematic given the high cost of app development and because the majority of downloaded apps fail to engage users over the long term. Objective The aim of this study was to take a qualitative approach to provide practical insight regarding this population’s preferences for the features and messages of an app to increase PA. Methods A total of 35 cancer survivors each attended 2 focus groups; a moderator presented slide shows on potential app features and messages and asked open-ended questions to elicit participant preferences. All sessions were audio recorded and transcribed verbatim. Three reviewers independently conducted thematic content analysis on all transcripts, then organized and consolidated findings to identify salient themes. Results Participants (mean age 63.7, SD 10.8, years) were mostly female (24/35, 69%) and mostly white (25/35, 71%). Participants generally had access to technology and were receptive to engaging with an app to increase PA. Themes identified included preferences for (1) a casual, concise, and positive tone, (2) tools for personal goal attainment, (3) a prescription for PA, and (4) an experience that is tailored to the user. Participants reported wanting extensive background data collection with low data entry burden and to have a trustworthy source translate their personal data into individualized PA recommendations. They expressed a desire for app functions that could facilitate goal achievement and articulated a preference for a more private social experience. Finally, results indicated that PA goals might be best established in the context of personally held priorities and values. Conclusions Many of the desired features identified are compatible with both empirically supported methods of behavior change and the relative strengths of an app as a delivery vehicle for behavioral intervention. Participating cancer survivors’ preferences contrasted with many current standard practices for mobile app development, including value-based rather than numeric goals, private socialization in small groups rather than sharing with broader social networks, and interpretation of PA data rather than merely providing numerical data. Taken together, these insights may help increase the acceptability of theory-based mHealth PA interventions in cancer survivors.
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Affiliation(s)
- Michael C Robertson
- Center for Energy Balance, Department of Behavioral Science, MD Anderson Cancer Center, Houston, TX, United States.,Health Promotion & Behavioral Sciences, University of Texas School of Public Health, Houston, TX, United States
| | - Edward Tsai
- Center for Energy Balance, Department of Behavioral Science, MD Anderson Cancer Center, Houston, TX, United States.,Health Promotion & Behavioral Sciences, University of Texas School of Public Health, Houston, TX, United States
| | - Elizabeth J Lyons
- Department of Nutrition and Metabolism, University of Texas Medical Branch, Galveston, TX, United States
| | - Sanjana Srinivasan
- Epidemiology, Human Genetics & Environmental Sciences, University of Texas School of Public Health, Houston, TX, United States
| | - Maria C Swartz
- Center for Recovery, Physical Activity and Nutrition, Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, United States
| | - Miranda L Baum
- Center for Energy Balance, Department of Behavioral Science, MD Anderson Cancer Center, Houston, TX, United States
| | - Karen M Basen-Engquist
- Center for Energy Balance, Department of Behavioral Science, MD Anderson Cancer Center, Houston, TX, United States
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Abstract
Given the number of lives affected by cancer and the great potential for optimizing well-being via lifestyle changes, patients, providers, health care systems, advocacy groups, and entrepreneurs are looking to digital solutions to enhance patient care and broaden prevention efforts. Thousands of health-oriented mobile websites and apps have been developed, with a majority focused upon lifestyle behaviors (e.g., exercise, diet, smoking). In this review, we consider the use and potential of social media and mHealth technologies for cancer prevention, cancer treatment, and survivorship. We identify key principles in research and practice, summarize prior reviews, and highlight notable case studies and patient resources. Further, with the potential for scaled delivery and broad reach, we consider application of social media and mHealth technologies in low-resource settings. With clear advantages for reach, social media and mHealth technologies offer the ability to scale and engage entire populations at low cost, develop supportive social networks, connect patients and providers, encourage adherence with cancer care, and collect vast quantities of data for advancing cancer research. Development efforts have been rapid and numerous, yet evaluation of intervention effects on behavior change and health outcomes are sorely needed, and regulation around data security issues is notably lacking. Attention to broader audiences is also needed, with targeted development for culturally diverse groups and non-English speakers. Further investment in research to build the evidence base and identify best practices will help delineate and actualize the potential of social media and mHealth technologies for cancer prevention and treatment.
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Affiliation(s)
- Judith J Prochaska
- From the Department of Medicine, Stanford Prevention Research Center, Stanford University, Stanford, CA; Department of Clinical and Digital Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA; Department of Nutrition and Metabolism, The University of Texas Medical Branch, Galveston, TX
| | - Steven S Coughlin
- From the Department of Medicine, Stanford Prevention Research Center, Stanford University, Stanford, CA; Department of Clinical and Digital Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA; Department of Nutrition and Metabolism, The University of Texas Medical Branch, Galveston, TX
| | - Elizabeth J Lyons
- From the Department of Medicine, Stanford Prevention Research Center, Stanford University, Stanford, CA; Department of Clinical and Digital Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, GA; Department of Nutrition and Metabolism, The University of Texas Medical Branch, Galveston, TX
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Baranowski T, Blumberg F, Gao Z, Kato PM, Kok G, Lu AS, Lyons EJ, Morrill BA, Peng W, Prins PJ, Snyder L, Staiano AE, Thompson D. Getting Research on Games for Health Funded. Games Health J 2016; 6:1-8. [PMID: 28026985 DOI: 10.1089/g4h.2016.0106] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Tom Baranowski
- 1 Department of Pediatrics, USDA/ARS Children's Nutrition Research Center , Baylor College of Medicine, Houston, Texas
| | - Fran Blumberg
- 2 Division of Psychological and Educational Services, Fordham University Graduate School of Education , New York, New York
| | - Zan Gao
- 3 School of Kinesiology, University of Minnesota , Minneapolis, Minnesota
| | - Pamela M Kato
- 4 Serious Games Institute, Coventry University , Coventry, United Kingdom
| | - Gerjo Kok
- 5 Department of Work and Social Psychology, Maastricht University , Maastricht, The Netherlands
| | - Amy S Lu
- 6 Department of Communication Studies, College of Arts, Media & Design; College of Health Sciences, Northeastern University , Boston, Massachusetts
| | - Elizabeth J Lyons
- 7 Department of Nutrition and Metabolism, The University of Texas Medical Branch , Galveston, Texas
| | | | - Wei Peng
- 9 Department of Media and Information, Michigan State University , East Lansing, Michigan
| | - Pier J Prins
- 10 Department of Developmental Psychology, University of Amsterdam , Amsterdam, The Netherlands
| | - Leslie Snyder
- 11 Department of Communication, Center for Health Intervention & Prevention, University of Connecticut , Storrs, Connecticut
| | - Amanda E Staiano
- 12 Pennington Biomedical Research Center, Louisiana State University , Baton Rouge, Louisiana
| | - Debbe Thompson
- 1 Department of Pediatrics, USDA/ARS Children's Nutrition Research Center , Baylor College of Medicine, Houston, Texas
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Swartz M, Lewis ZH, Lyons EJ, Middleton A, Jennings K, Ottenbacher K, Goodwin J. NIDILRR: Efficacy of Home and Community-Based Physical Activity Interventions on Physical Function Among Cancer Survivors: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2016. [DOI: 10.1016/j.apmr.2016.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Lewis ZH, Ottenbacher KJ, Fisher SR, Jennings K, Brown AF, Swartz MC, Lyons EJ. Testing Activity Monitors' Effect on Health: Study Protocol for a Randomized Controlled Trial Among Older Primary Care Patients. JMIR Res Protoc 2016; 5:e59. [PMID: 27129602 PMCID: PMC4867768 DOI: 10.2196/resprot.5454] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 01/19/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cardiovascular disease is the leading cause of mortality in the United States. Maintaining healthy levels of physical activity is critical to cardiovascular health, but many older adults are inactive. There is a growing body of evidence linking low motivation and inactivity. Standard behavioral counseling techniques used within the primary care setting strive to increase motivation, but often do not emphasize the key component of self-control. The addition of electronic activity monitors (EAMs) to counseling protocols may provide more effective behavior change and increase overall motivation for exercise through interactive self-monitoring, feedback, and social support from other users. OBJECTIVE The objective of the study is to conduct a three month intervention trial that will test the feasibility of adding an EAM system to brief counseling within a primary care setting. Participants (n=40) will be randomized to receive evidence-based brief counseling plus either an EAM or a pedometer. METHODS Throughout the intervention, we will test its feasibility and acceptability, the change in primary outcomes (cardiovascular risk and physical activity), and the change in secondary outcomes (adherence, weight and body composition, health status, motivation, physical function, psychological feelings, and self-regulation). Upon completion of the intervention, we will also conduct focus groups with the participants and with primary care stakeholders. RESULTS The study started recruitment in October 2015 and is scheduled to be completed by October 2016. CONCLUSIONS This project will lay the groundwork and establish the infrastructure for intervention refinement and ultimately translation within the primary care setting in order to prevent cardiovascular disease on a population level. TRIAL REGISTRATION ClinicalTrials.gov NCT02554435; https://clinicaltrials.gov/ct2/show/NCT02554435 (Archived by WebCite at http://www.webcitation/6fUlW5tdT).
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Affiliation(s)
- Zakkoyya H Lewis
- University of Texas Medical Branch, Division of Rehabilitation Sciences, Galveston, TX, United States.
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Swartz MC, Basen-Engquist KM, Markham C, Lyons EJ, Cox M, Chandra J, Ater JL, Askins MA, Scheurer ME, Lupo PJ, Hill R, Murray J, Chan W, Swank PR. Psychometric Analysis of the Three-Factor Eating Questionnaire-R18V2 in Adolescent and Young Adult-Aged Central Nervous System Tumor Survivors. J Adolesc Young Adult Oncol 2016; 5:278-85. [PMID: 27042872 DOI: 10.1089/jayao.2015.0058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Adolescent and young adult (AYA)-aged central nervous system (CNS) tumor survivors are an understudied population that is at risk of developing adverse health outcomes, such as obesity. Long-term follow-up guidelines recommend monitoring those at risk of obesity, thus motivating the need for an eating behavior questionnaire. An abbreviated online version of the Three-Factor Eating Questionnaire (TFEQ-R18v2) has been developed, but its applicability to this population is not yet known. This study investigated the instrument's factor structure and reliability in this population. METHODS AYA-aged CNS tumor survivors (n = 114) aged 15-39 years completed the TFEQ-R18V2 questionnaire online. Confirmatory factor analysis was used to examine the fit of the three-factor structure (uncontrollable eating, cognitive restraint, and emotional eating [EE]) and reliability (internal consistency of the TFEQ-R18v2). Associations between the three factors and body mass index (BMI) were assessed by linear regression. RESULTS The theorized three-factor structure was supported in our population (RMSEA = 0.056 and CFI = 0.98) and demonstrated good reliability (α of 0.81-0.93). EE (β = 0.07, 95% CI 0.02-0.13) was positively associated with BMI, whereas the other two subscale scores were not. CONCLUSION The TFEQ-R18v2 instrument holds promise for research and clinical use among AYA-aged CNS tumor survivors. The instrument may be a useful tool for researchers to develop tailored weight management strategies. It also may be a valuable tool for clinicians to monitor survivors who are at risk of obesity and to facilitate referral. Our results also suggest that EE in this population should be further investigated as a potential target for intervention.
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Affiliation(s)
- Maria C Swartz
- 1 Division of Rehabilitation Sciences, The University of Texas Medical Branch , Galveston, Texas
| | - Karen M Basen-Engquist
- 2 Department of Behavioral Science, The University of Texas MD Anderson Cancer Center , Houston, Texas
| | - Christine Markham
- 3 Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas
| | - Elizabeth J Lyons
- 1 Division of Rehabilitation Sciences, The University of Texas Medical Branch , Galveston, Texas
| | - Matthew Cox
- 2 Department of Behavioral Science, The University of Texas MD Anderson Cancer Center , Houston, Texas
| | - Joya Chandra
- 4 Division of Pediatrics, The University of Texas MD Anderson Cancer Center , Houston, Texas
| | - Joann L Ater
- 4 Division of Pediatrics, The University of Texas MD Anderson Cancer Center , Houston, Texas
| | - Martha A Askins
- 4 Division of Pediatrics, The University of Texas MD Anderson Cancer Center , Houston, Texas
| | | | - Philip J Lupo
- 5 Department of Pediatrics, Baylor College of Medicine , Houston, Texas
| | - Rachel Hill
- 6 Department of Hematology & Oncology, Cook Children's Medical Center , Fort Worth, Texas
| | - Jeffrey Murray
- 6 Department of Hematology & Oncology, Cook Children's Medical Center , Fort Worth, Texas
| | - Wenyaw Chan
- 7 Department of Biostatistics, The University of Texas Health Science Center at Houston School of Public Health , Houston, Texas
| | - Paul R Swank
- 3 Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, Texas
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Lyons EJ, Baranowski T, Basen-Engquist KM, Lewis ZH, Swartz MC, Jennings K, Volpi E. Testing the effects of narrative and play on physical activity among breast cancer survivors using mobile apps: study protocol for a randomized controlled trial. BMC Cancer 2016; 16:202. [PMID: 26960972 PMCID: PMC4784467 DOI: 10.1186/s12885-016-2244-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 03/02/2016] [Indexed: 01/02/2023] Open
Abstract
Background Physical activity reduces risk for numerous negative health outcomes, but postmenopausal breast cancer survivors do not reach recommended levels. Many interventions encourage self-monitoring of steps, which can increase physical activity in the short term. However, these interventions appear insufficient to increase motivation for sustained change. There is a need for innovative strategies to increase physical activity motivation in this population. Narratives are uniquely persuasive, and video games show promise for increasing motivation. This study will determine the effectiveness of an intervention that combines narrative and gaming to encourage sustained physical activity. Methods/Design SMARTGOAL (Self-Monitoring Activity: a Randomized Trial of Game-Oriented AppLications) is a randomized controlled intervention trial. The intervention period is six months, followed by a six month maintenance period. Participants (overweight, sedentary postmenopausal breast cancer survivors aged 45–75) will be randomized to a self-monitoring group or an enhanced narrative game group. The self-monitoring group will be encouraged to use a mobile application for self-monitoring and feedback and will receive 15 counseling phone calls emphasizing self-regulation. The narrative game group will be encouraged to use a mobile application that includes self-monitoring and feedback as well as a narrative-based active video game. The 15 calls for this group will emphasize concepts related to the game storyline. Counseling calls in both groups will occur weekly in months 1 – 3 and monthly in months 4 – 6. No counseling calls will occur after month 6, but both groups will be encouraged to continue using their apps. The primary outcome of the study is minutes of moderate to vigorous physical activity at six months. Other objectively measured outcomes include fitness and physical function. Self-reported outcomes include quality of life, depression, and motivation. Discussion This protocol will result in implementation and evaluation of two technology-based physical activity interventions among breast cancer survivors. Both interventions hold promise for broad dissemination. Understanding the potential benefit of adding narrative and game elements to interventions will provide critical information to interventionists, researchers, clinicians, and policymakers. This study is uniquely suited to investigate not just whether but how and why game elements may improve breast cancer survivors’ health. Trial registration clinicaltrials.gov NCT02341235 (January 9, 2015) Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2244-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elizabeth J Lyons
- Department of Nutrition and Metabolism, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555-1124, USA.
| | - Tom Baranowski
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, 1100 Bates St, Houston, TX, 77030, USA
| | - Karen M Basen-Engquist
- Department of Behavioral Science and Center for Energy Balance in Cancer Prevention and Survivorship, M.D. Anderson Cancer Center, 1155 Pressler St, Houston, TX, 77030, USA
| | - Zakkoyya H Lewis
- Division of Rehabilitation Sciences, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
| | - Maria C Swartz
- Division of Rehabilitation Sciences, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
| | - Kristofer Jennings
- Department of Preventive Medicine and Community Health, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
| | - Elena Volpi
- Department of Geriatrics and Claude D. Pepper Older Americans Independence Center, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
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Martin EC, Basen-Engquist K, Cox MG, Lyons EJ, Carmack CL, Blalock JA, Demark-Wahnefried W. Interest in Health Behavior Intervention Delivery Modalities Among Cancer Survivors: A Cross-Sectional Study. JMIR Cancer 2016; 2:e1. [PMID: 28410164 PMCID: PMC5369635 DOI: 10.2196/cancer.5247] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 12/28/2015] [Accepted: 01/03/2016] [Indexed: 01/30/2023] Open
Abstract
Background Effective, broad-reaching channels are important for the delivery of health behavior interventions in order to meet the needs of the growing population of cancer survivors in the United States. New technology presents opportunities to increase the reach of health behavior change interventions and therefore their overall impact. However, evidence suggests that older adults may be slower in their adoption of these technologies than the general population. Survivors’ interest for more traditional channels of delivery (eg, clinic) versus new technology-based channels (eg, smartphones) may depend on a variety of factors, including demographics, current health status, and the behavior requiring intervention. Objective The aim of this study was to determine the factors that predict cancer survivors’ interest in new technology-based health behavior intervention modalities versus traditional modalities. Methods Surveys were mailed to 1871 survivors of breast, prostate, and colorectal cancer. Participants’ demographics, diet and physical activity behaviors, interest in health behavior interventions, and interest in intervention delivery modalities were collected. Using path analysis, we explored the relationship between four intervention modality variables (ie, clinic, telephone, computer, and smartphone) and potential predictors of modality interest. Results In total, 1053 respondents to the survey (56.3% response rate); 847 provided complete data for this analysis. Delivery channel interest was highest for computer-based interventions (236/847, 27.9% very/extremely interested) and lowest for smartphone–based interventions (73/847, 8.6%), with interest in clinic-based (147/847, 17.3%) and telephone-delivered (143/847, 16.9%) falling in between. Use of other technology platforms, such as Web cameras and social networking sites, was positively predictive of interest in technology-based delivery channels. Older survivors were less likely to report interest in smartphone–based diet interventions. Physical activity, fruit and vegetable consumption, weight status, and age moderated relationships between interest in targeted intervention behavior and modality. Conclusions This study identified several predictors of survivor interest in various health behavior intervention delivery modalities. Overall, computer-based interventions were found to be most acceptable, while smartphones were the least. Factors related to survivors’ current technology use and health status play a role in their interest for technology-based intervention versus more traditional delivery channels. Future health behavior change research in this population should consider participants’ demographic, clinical, and lifestyle characteristics when selecting a delivery channel. Furthermore, current health behavior interventions for older cancer survivors may be best delivered over the Internet. Smartphone interventions may be feasible in the future following further adoption and familiarization by this particular population.
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Affiliation(s)
- Emily C Martin
- University of Texas MD Anderson Cancer Center, Department of Behavioral Science, Houston, TX, United States
| | - Karen Basen-Engquist
- University of Texas MD Anderson Cancer Center, Department of Behavioral Science, Houston, TX, United States
| | - Matthew G Cox
- University of Texas MD Anderson Cancer Center, Department of Behavioral Science, Houston, TX, United States
| | - Elizabeth J Lyons
- The University of Texas Medical Branch, Department of Nutrition and Metabolism, Galveston, TX, United States
| | - Cindy L Carmack
- University of Texas MD Anderson Cancer Center, Department of Palliative, Rehabilitation and Integrative Medicine, Houston, TX, United States
| | - Janice A Blalock
- University of Texas MD Anderson Cancer Center, Department of Behavioral Science, Houston, TX, United States
| | - Wendy Demark-Wahnefried
- University of Alabama at Birmingham, Department of Nutrition Sciences, Birmingham, AL, United States
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Abstract
Rewards are commonly used in interventions to change behavior, but they can inhibit development of intrinsic motivation, which is associated with long-term behavior maintenance. Gamification is a novel intervention strategy that may target intrinsic motivation through fun and enjoyment. Before the effects of gamified interventions on motivation can be determined, there must be an understanding of how gamified interventions operationalize rewards, such as point systems. The purpose of this review is to determine the prevalence of different reward types, specifically point systems, within gamified interventions. Electronic databases were searched for relevant articles. Data sources included Medline OVID, Medline PubMed, Web of Science, CINAHL, Cochrane Central, and PsycINFO. Out of the 21 articles retrieved, 18 studies described a reward system and were included in this review. Gamified interventions were designed to target a myriad of clinical outcomes across diverse populations. Rewards included points (n = 14), achievements/badges/medals (n = 7), tangible rewards (n = 7), currency (n = 4), other unspecified rewards (n = 3), likes (n = 2), animated feedback (n = 1), and kudos (n = 1). Rewards, and points in particular, appear to be a foundational component of gamified interventions. Despite their prevalence, authors seldom described the use of noncontingent rewards or how the rewards interacted with other game features. The reward systems relying on tangible rewards and currency may have been limited by inhibited intrinsic motivation. As gamification proliferates, future research should explicitly describe how rewards were operationalized in the intervention and evaluate the effects of gamified rewards on motivation across populations and research outcomes.
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Affiliation(s)
- Zakkoyya H Lewis
- 1 Division of Rehabilitation Sciences, University of Texas Medical Branch , Galveston, Texas
| | - Maria C Swartz
- 1 Division of Rehabilitation Sciences, University of Texas Medical Branch , Galveston, Texas
| | - Elizabeth J Lyons
- 1 Division of Rehabilitation Sciences, University of Texas Medical Branch , Galveston, Texas.,2 Department of Nutrition and Metabolism, University of Texas Medical Branch , Galveston, Texas.,3 Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch , Galveston, Texas
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Lewis ZH, Lyons EJ, Jarvis JM, Baillargeon J. Using an electronic activity monitor system as an intervention modality: A systematic review. BMC Public Health 2015; 15:585. [PMID: 26104189 PMCID: PMC4479243 DOI: 10.1186/s12889-015-1947-3] [Citation(s) in RCA: 130] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 06/17/2015] [Indexed: 11/16/2022] Open
Abstract
Background Obesity is a growing global health concern that may lead to cardiovascular disease, type II diabetes, and cancer. Several systematic reviews have shown that technology is successful in combating obesity through increased physical activity, but there is no known review on interventions that use an electronic activity monitor system (EAMS). EAMSs are defined as a wearable device that objectively measures lifestyle physical activity and can provide feedback, beyond the display of basic activity count information, via the monitor display or through a partnering application to elicit continual self-monitoring of activity behavior. These devices improve upon standard pedometers because they have the ability to provide visual feedback on activity progression, verbal encouragement, and social comparison. This systematic review aimed to synthesize the efficacy and feasibility results of EAMSs within published physical activity interventions. Methods Electronic databases and journal references were searched for relevant articles. Data sources included CINAHL, Cochrane CENTRAL, Medline Ovid, PsycINFO, and clinicaltrials.gov. Out of the 1,574 retrieved, 11 articles met the inclusion criteria. These articles were reviewed for quality and content based on a risk of bias tool and intervention components. Results Most articles were determined to be of medium quality while two were of low quality, and one of high quality. Significant pre-post improvements in the EAMS group were found in five of nine studies for physical activity and in four of five studies for weight. One found a significant increase in physical activity and two studies found significant weight loss in the intervention group compared with the comparator group. The EAMS interventions appear to be feasible with most studies reporting continual wear of the device during waking hours and a higher retention rate of participants in the EAMS groups. Conclusion These studies provide preliminary evidence suggesting that EAMS can increase physical activity and decrease weight significantly, but their efficacy compared to other interventions has not yet been demonstrated. More high-quality randomized controlled trials are needed to evaluate the overall effect of EAMS, examine which EAMS features are most effective, and determine which populations are most receptive to an EAMS. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1947-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Zakkoyya H Lewis
- Division of Rehabilitation Sciences, University of Texas Medical Branch (UTMB), 301 University Blvd, Galveston, TX, USA. .,Department of Preventive Medicine & Community Health, UTMB, Galveston, TX, USA.
| | - Elizabeth J Lyons
- Division of Rehabilitation Sciences, University of Texas Medical Branch (UTMB), 301 University Blvd, Galveston, TX, USA. .,Department of Nutrition and Metabolism, UTMB, Galveston, TX, USA. .,Center for Interdisciplinary Research in Women's Health, UTMB, Galveston, TX, USA.
| | - Jessica M Jarvis
- Division of Rehabilitation Sciences, University of Texas Medical Branch (UTMB), 301 University Blvd, Galveston, TX, USA. .,Department of Preventive Medicine & Community Health, UTMB, Galveston, TX, USA.
| | - Jacques Baillargeon
- Department of Preventive Medicine & Community Health, UTMB, Galveston, TX, USA. .,Division of Epidemiology and Outcomes, Correctional Managed Care, UTMB, Galveston, TX, USA.
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Monedero J, Lyons EJ, O’Gorman DJ. Interactive video game cycling leads to higher energy expenditure and is more enjoyable than conventional exercise in adults. PLoS One 2015; 10:e0118470. [PMID: 25738290 PMCID: PMC4349455 DOI: 10.1371/journal.pone.0118470] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 01/18/2015] [Indexed: 12/24/2022] Open
Abstract
Background Despite the widely accepted health benefits of regular physical activity, only a small percentage of the population meets the current recommendations. The reasons include a wide use of technology and a lack of enjoyment while exercising. The purpose of this study was to compare the physiological, perceptual and enjoyment responses between a single bout of (I) conventional cycling and (II) interactive cycling video game at a matched workload. Methods A cross-sectional study in 34 healthy participants was performed. Initially, participants completed an incremental maximal cycling test to measure peak oxygen uptake and to determine ventilatory threshold. In random order, participants carried out a 30 min interactive cycling trial and a 30 min conventional cycling trial at 55% of peak power output. During the trials, oxygen uptake and energy expenditure were measured by open-circuit spirometry and heart rate was measured by radiotelemetry. RPE and enjoyment were measured every 10 minutes with Borg scale and a modified PACES scale. Results Interactive cycling resulted in a significantly greater %V̇O2Reserve (68.2% ± 9.2% vs 64.7% ± 8.1%), rate of energy expenditure (505.8±75.2 vs 487.4±81.2 j·kg-1·min-1), and enjoyment (63.4% ± 17 vs 42% ± 13.6), P<0.05. Participants were working at a higher intensity in relation to the individual’s ventilatory threshold during the interactive cycling video game trial (M = 11.86, SE = 3.08) than during the Conventional cycling trial (M = 7.55, SE = 3.16, t(33) = -2.69, P<0.05, r = .42). No significant differences were found for heart rate reserve (72.5 ± 10.4 vs 71.4±10.1%) and RPE (13.1 ± 1.8 vs 13.2 ± 1.7). Conclusion Interactive cycling games can be a valid alternative to conventional exercise as they result in a higher exercise intensity than conventional cycling and a distraction from aversive cognitive and physiological states at and above the ventilatory threshold.
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Affiliation(s)
- Javier Monedero
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
| | - Elizabeth J. Lyons
- University of Texas Medical Branch at Galveston, Institute for Translational Sciences, Galveston, Texas, United States of America
| | - Donal J. O’Gorman
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Centre for Preventive Medicine, Dublin City University, Dublin, Ireland
- * E-mail:
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Tate DF, Lyons EJ, Valle CG. High-tech tools for exercise motivation: use and role of technologies such as the internet, mobile applications, social media, and video games. Diabetes Spectr 2015; 28:45-54. [PMID: 25717278 PMCID: PMC4334081 DOI: 10.2337/diaspect.28.1.45] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
IN BRIEF The majority of patients with type 2 diabetes are not active at recommended levels, and many do not have access to behavior change programs to support lifestyle change. Thus, tools and programs designed to promote the adoption and maintenance of physical activity using technology may be helpful. This article reviews the evidence regarding the use of technology tools such as the Internet, mobile applications, social media, and video games and provides suggestions for evaluating the potential benefit of such tools for behavior change.
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Affiliation(s)
- Deborah F. Tate
- Departments of Health Behavior and Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Elizabeth J. Lyons
- Institute for Translational Sciences, The University of Texas Medical Branch, Galveston, TX
| | - Carmina G. Valle
- Cancer Health Disparities Training Program, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, CHapel Hill, NC
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Abstract
OBJECTIVE This article reviews theoretical and empirical evidence related to three mechanisms for encouraging enjoyment during exergame play: Feedback, challenge, and rewards. MATERIALS AND METHODS A literature search and narrative review were conducted. RESULTS Feedback is found in nearly all exergames, and richer, more in-depth feedback is associated with increased activity. Challenge is a vital component of any videogame, and exergames include physical as well as cognitive challenges. Flow states have traditionally been conceptualized as occurring when an optimal match between player skills and game challenge occurs. However, failure and retrial are necessary for feelings of overall satisfaction and fun, despite not necessarily being ideally fun or satisfying themselves. Rewards are a more complicated issue, with significant theoretical and empirical evidence suggesting positive and negative effects of reward systems. How rewards are integrated into the mechanics and storyline of the game likely impacts how they are perceived and, thus, their effectiveness. Finally, integration of these mechanisms into exergames requires specific attention to both cognitive and physical implementations. Movements that are not themselves enjoyable or engaging may lead to cheating and lower energy expenditure. CONCLUSIONS Feedback, challenge, and rewards are promising mechanisms by which exergames could become more enjoyable. How these concepts are operationalized can affect physical and psychological reactions to exergames. Attention to these concepts in future exergame development and implementation would benefit theory, research, and practice.
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Affiliation(s)
- Elizabeth J Lyons
- Institute for Translational Sciences, University of Texas Medical Branch , Galveston, Texas
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Lyons EJ, Lewis ZH, Mayrsohn BG, Rowland JL. Behavior change techniques implemented in electronic lifestyle activity monitors: a systematic content analysis. J Med Internet Res 2014; 16:e192. [PMID: 25131661 PMCID: PMC4147713 DOI: 10.2196/jmir.3469] [Citation(s) in RCA: 317] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 07/30/2014] [Accepted: 07/30/2014] [Indexed: 12/17/2022] Open
Abstract
Background Electronic activity monitors (such as those manufactured by Fitbit, Jawbone, and Nike) improve on standard pedometers by providing automated feedback and interactive behavior change tools via mobile device or personal computer. These monitors are commercially popular and show promise for use in public health interventions. However, little is known about the content of their feedback applications and how individual monitors may differ from one another. Objective The purpose of this study was to describe the behavior change techniques implemented in commercially available electronic activity monitors. Methods Electronic activity monitors (N=13) were systematically identified and tested by 3 trained coders for at least 1 week each. All monitors measured lifestyle physical activity and provided feedback via an app (computer or mobile). Coding was based on a hierarchical list of 93 behavior change techniques. Further coding of potentially effective techniques and adherence to theory-based recommendations were based on findings from meta-analyses and meta-regressions in the research literature. Results All monitors provided tools for self-monitoring, feedback, and environmental change by definition. The next most prevalent techniques (13 out of 13 monitors) were goal-setting and emphasizing discrepancy between current and goal behavior. Review of behavioral goals, social support, social comparison, prompts/cues, rewards, and a focus on past success were found in more than half of the systems. The monitors included a range of 5-10 of 14 total techniques identified from the research literature as potentially effective. Most of the monitors included goal-setting, self-monitoring, and feedback content that closely matched recommendations from social cognitive theory. Conclusions Electronic activity monitors contain a wide range of behavior change techniques typically used in clinical behavioral interventions. Thus, the monitors may represent a medium by which these interventions could be translated for widespread use. This technology has broad applications for use in clinical, public health, and rehabilitation settings.
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Affiliation(s)
- Elizabeth J Lyons
- The University of Texas Medical Branch, Institute for Translational Sciences, Galveston, TX, United States.
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46
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Abstract
Feedback on game performance can be provided in many ways (e.g., cumulative points on game achievements, points on selected aspects of game play, biofeedback, brief statements offered during gameplay on choices made, verbal feedback at end of gameplay on overall performance, etc.). Feedback could be used motivationally to maintain player interest and involvement, informationally to guide the player in more effective choices, to build player confidence, and for a variety of other purposes. Although diverse feedback types and purposes are possible, some are more likely to be useful and effective. We have contacted several accomplished game designers and game researchers to obtain their insights into issues in feedback in Games for Health Journal.
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Affiliation(s)
- Moderator Tom Baranowski
- 1 Baylor College of Medicine , Houston, Texas; and Editor, Games for Health Journal: Research, Development, and Clinical Applications
| | | | - Paul Krebs
- 3 New York University Medical Center , New York, New York
| | - Claudine J Lamoth
- 4 University of Groningen , University Medical Center Groningen, Groningen, The Netherlands
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Abstract
There has been a debate about whether entertainment videogames should incorporate story or narrative. A concern has been whether story cut scenes break game immersion, and thereby minimize the fun of gameplay. Alternatively, games for health (G4H) have an agenda that goes beyond just having fun. The possible role of story in G4H has not been thoroughly addressed. We have assembled a group of experts who have worked with stories in G4H, and asked some pointed questions.
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Affiliation(s)
- Moderator Tom Baranowski
- 1 Baylor College of Medicine , Houston, Texas; and Editor, Games for Health Journal: Research, Development, and Clinical Applications
| | | | | | | | - Jesse Schell
- 5 Schell Games, Pittsburgh , Pennsylvania.,6 Carnegie Mellon University , Pittsburgh, Pennsylvania
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48
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Abstract
Many investigators are considering developing videogames for health (video-G4Hs) but have questions about how to get started. This report provides guidance for investigators considering a G4H as a behavioral intervention procedure from a team of experienced G4H developers. Thirteen commonly asked questions are answered, including defining a G4H, considerations in developing a team, considerations in G4H design, and anticipating unintended consequences.
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Affiliation(s)
- Tom Baranowski
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | | | - Debbe Thompson
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Elizabeth J Lyons
- Institute for Translational Sciences, The University of Texas Medical Branch, Galveston, Texas
| | - Amy Shirong Lu
- Department of Communication Studies, School of Communication, Northwestern University, Evanston, Illinois
| | - Janice Baranowski
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
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Mellecker R, Lyons EJ, Baranowski T. Disentangling Fun and Enjoyment in Exergames Using an Expanded Design, Play, Experience Framework: A Narrative Review. Games Health J 2013; 2:142-149. [PMID: 24761322 DOI: 10.1089/g4h.2013.0022] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
With exergames (as with physical activity in general), more intense and longer-duration game play should accrue more health benefits. Exergames, however, appear to be played for relatively short durations, often at medium or lower intensities. Ostensibly games are played for fun or enjoyment. Enhancing the fun or enjoyment experienced during exergame play should enhance the intensity and duration of physical activity, and thereby the health benefits. Research, reviewed herein, indicates fun and/or enjoyment in games are inherently laden with psychosocial, physiological, and embodiment substrates. Physical activity may also have separate or closely related psychosocial, physiological, and embodiment enjoyment substrates. Research is needed to integrate these levels of experience and to identify the game mechanics that enhance, and even maximize, the fun or enjoyment experienced in exergames, to thereby increase the health benefit.
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Affiliation(s)
- Robin Mellecker
- University of Hong Kong, Institute of Human Performance , Pokfulam, Hong Kong
| | - Elizabeth J Lyons
- Institute for Translational Sciences, The University of Texas Medical Branch , Galveston, Texas
| | - Tom Baranowski
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine , Houston, Texas
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Lyons EJ, Tate DF, Ward DS. The better the story, the bigger the serving: narrative transportation increases snacking during screen time in a randomized trial. Int J Behav Nutr Phys Act 2013; 10:60. [PMID: 23680389 PMCID: PMC3660271 DOI: 10.1186/1479-5868-10-60] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 05/14/2013] [Indexed: 11/23/2022] Open
Abstract
Background Watching television and playing video games increase energy intake, likely due to distraction from satiety cues. A study comparing one hour of watching TV, playing typical video games, or playing motion-controlled video games found a difference across groups in energy intake, but the reasons for this difference are not clear. As a secondary analysis, we investigated several types of distraction to determine potential psychosocial mechanisms which may account for greater energy intake observed during sedentary screen time as compared to motion-controlled video gaming. Methods Feelings of enjoyment, engagement (mental immersion), spatial presence (the feeling of being in the game), and transportation (immersion in a narrative) were investigated in 120 young adults aged 18 – 35 (60 female). Results Only narrative transportation was associated with total caloric intake (ρ = .205, P = .025). Transportation was also higher in the TV group than in the gaming groups (P = .002) and higher in males than in females (P = .003). Transportation mediated the relationship between motion-controlled gaming (as compared to TV watching) and square root transformed energy intake (indirect effect = −1.34, 95% confidence interval −3.57, −0.13). No other distraction-related variables were associated with intake. Conclusions These results suggest that different forms of distraction may differentially affect eating behavior during screen time, and that narrative appears to be a particularly strong distractor. Future studies should further investigate the effects of narrative on eating behavior.
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Affiliation(s)
- Elizabeth J Lyons
- Department of Nutrition, Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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