Reach Out to Enhance Wellness Home-Based Diet-Exercise Intervention Promotes Reproducible and Sustainable Long-Term Improvements in Health Behaviors, Body Weight, and Physical Functioning in Older, Overweight/Obese Cancer Survivors
Reach Out to Enhance Wellness Home-Based Diet-Exercise Intervention Promotes Reproducible and Sustainable Long-Term Improvements in Health Behaviors, Body Weight, and Physical Functioning in Older, Overweight/Obese Cancer Survivors
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DOI：
10.1200/jco.2011.40.0895
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发表时间：
2012-07-01
影响因子：
45.3
通讯作者：
Cohen, Harvey J.
中科院分区：
文献类型：
--
作者：
Demark-Wahnefried, Wendy;Morey, Miriam C.;Cohen, Harvey J.
饮食和运动干预已经在癌症幸存者中进行了测试，作为减少晚期效应和合并症的一种手段，但很少有人评估长期的依从性和健康结果。在美国（21个州）、加拿大和英国的结直肠癌、乳腺癌和前列腺癌幸存者中（诊断后>= 5年）。所有参与者都是久坐不动的（每周< 150分钟的体力活动[PA]），超重或肥胖（体重指数，25至40 kg/m2），年龄超过65岁。该试验测试了通过邮寄印刷材料和电话咨询提供的饮食运动干预。RENEW使用了等待列表对照、交叉设计（即，参与者立即或延迟1年后接受为期一年的干预），这使得有机会评估项目疗效（先前报告的主要结局）、耐久性和再现性（本文报告）。措施包括饮食质量（DQ），PA，BMI，和身体功能（PF）。结果没有显着的复发，观察到在立即干预的DQ，PA，和BMI臂;然而，功能下降的速度增加时，干预停止。从第1年到第2年，延迟干预组观察到显著改善;行为、BMI和PF斜率的平均变化评分如下：DQ评分，5.2（95% CI，3.4至7.0）; PA，45.8 min/wk（95% CI，26.9至64.6 min/wk）; BMI，-0.56（95% CI，-0.75至-0.36）;简表-36 PF，-1.02 vs.-5.52（所有指标P <0.001）。总体而言，两个武器经历了显着改善DQ，PA，和BMI从基线到2年follow-up（P <0.001）。ConclusionOlder癌症幸存者积极响应生活方式干预，并作出持久的变化DQ和PA，有助于持续减肥。这些变化积极地重新定向功能下降轨迹在干预交付。
PurposeDiet and exercise interventions have been tested in cancer survivors as a means to reduce late effects and comorbidity, but few have assessed adherence and health outcomes long term.MethodsBetween July 2005 and May 2007, the Reach Out to Enhance Wellness (RENEW) trial accrued 641 locoregionally staged, long-term (>= 5 years from diagnosis) colorectal, breast, and prostate cancer survivors in the United States (21 states), Canada, and the United Kingdom. All participants were sedentary (< 150 minutes of physical activity [PA] a week), overweight or obese (body mass index, 25 to 40 kg/m(2)), and over age 65 years. The trial tested a diet-exercise intervention delivered via mailed print materials and telephone counseling. RENEW used a wait-list control, cross-over design (ie, participants received the year-long intervention immediately or after a 1-year delay), which allowed the opportunity to assess program efficacy (previously reported primary outcome), durability, and reproducibility (reported herein). Measures included diet quality (DQ), PA, BMI, and physical function (PF).ResultsNo significant relapse was observed in the immediate-intervention arm for DQ, PA, and BMI; however, rates of functional decline increased when the intervention ceased. From year 1 to year 2, significant improvements were observed in the delayed-intervention arm; mean change scores in behaviors and BMI and PF slopes were as follows: DQ score, 5.2 (95% CI, 3.4 to 7.0); PA, 45.8 min/wk (95% CI, 26.9 to 64.6 min/wk); BMI, -0.56 (95% CI, -0.75 to -0.36); and Short Form-36 PF, -1.02 versus -5.52 (P < .001 for all measures). Overall, both arms experienced significant improvements in DQ, PA, and BMI from baseline to 2-year follow-up (P < .001).ConclusionOlder cancer survivors respond favorably to lifestyle interventions and make durable changes in DQ and PA that contribute to sustained weight loss. These changes positively reorient functional decline trajectories during intervention delivery.