Optimization of a mHealth Physical Activity Promotion Intervention with Mindful Awareness for Adolescent and Young Adult Cancer Survivors

项目总结/摘要 美国大约有68万青少年和年轻成人癌症幸存者（AYACS），和 这个群体的存活率正在上升。AYACS经历了无数与治疗相关的有害副作用 影响，身体和情绪问题的发生率较高，早期发病的风险较高， 与年龄匹配的非癌症对照组相比死亡率。增加中到高强度的体力活动 活动（MVPA）始终与生活质量（QOL）提高，癌症治疗减少， 相关的副作用和慢性疾病风险，并改善癌症幸存者的癌症预后。然而 大多数AYACS（~60%）不符合癌症特异性MVPA建议（即，150分钟/周），以及 很少有关于癌症幸存者MVPA的研究专门关注AYACS。现有研究 幸存者的MVPA在很大程度上是资源密集型的，昂贵的，并提供多个组件（即，教练电话， 监督练习）同时限制可扩展性。确定了三项循证战略 这可能对克服这些障碍和增加AYACS中的MVPA特别有用：1）电子 提供MVPA计划，2）社会支持，3）正念训练。然而，人们对这一问题知之甚少。 社会支持和正念在MVPA推广中的独特作用。有关 需要这些组件的离散效应来优化干预配置，以便最大限度地提高 有效和可扩展MVPA计划。本研究的目的是应用多相 优化策略（MOST），以确定哪些类型的社会支持和正念训练 干预成分在12周的mHealth MVPA干预中最佳地增加了MVPA， 随访MOST是一个改编自工程的框架，它使用高效的因子实验， 评估干预措施的单独和综合效果，以确定哪些措施可以 减少、消除或取代以提高效率。非活动性AYACS（n = 304）将接受核心干预 由OPTIMAL AYAO应用程序和Fitbit组成，并随机分配到4个组件， 纳入优化干预的考虑因素：1）一般正念训练; 2）MVPA特定 正念训练; 3）电子教练和4）伙伴的参与。我们还将研究增加 MVPA对症状负担、其他活动强度（即轻度和久坐）和睡眠质量的影响， 持续时间和潜在的调解人和主持人的组成部分的影响。这项研究是第一次 系统性的努力，使用MOST设计一个优化的，可扩展的mHealth MVPA干预AYACS。这 研究将导致更好地了解如何有效地改变AYACS的MVPA， 改善这一人群的健康和疾病状况。

PROJECT SUMMARY/ABSTRACT There are approximately 680,000 adolescent and young adult cancer survivors (AYACS) in the U.S., and the survival rate in this group is increasing. AYACS experience a myriad of deleterious treatment-related side effects, higher rates of physical and emotional problems and are at a heighted risk of early morbidity and mortality compared to non-cancer age-matched controls. Increased moderate to vigorous intensity physical activity (MVPA) is consistently associated with enhanced quality of life (QOL), reduced cancer treatment- related side effects and chronic disease risk, and improved cancer prognosis in cancer survivors. Yet, the majority of AYACS (~60%) do not meet cancer-specific MVPA recommendations (i.e., 150 mins/week), and very little research on MVPA in cancers survivors has focused specifically on AYACS. Existing studies of MVPA in survivors are largely resource-intensive, costly, and deliver multiple components (i.e., coaching calls, supervised exercise) simultaneously limiting scalability. Three evidence-based strategies have been identified that may be particularly useful for overcoming these barriers and increasing MVPA in AYACS: 1) electronic delivery of a MVPA program, 2) social support, and 3) mindfulness training. However, little is known on the unique roles of social support and mindfulness in MVPA promotion. More granular information about the discrete effects of these components is needed to optimize intervention configuration in order to maximize an effective and scalable MVPA program for AYACS. The purpose of this study is to apply the Multiphase Optimization Strategy (MOST), to determine which types of social support and mindfulness training intervention components optimally increase MVPA in a 12-week mHealth MVPA intervention with a 12 week follow-up. MOST is a framework adapted from engineering that uses highly efficient factorial experiments to evaluate individual, and combined, effects of intervention components to determine which ones can be reduced, eliminated or replaced to improve efficiency. Inactive AYACS (n=304) will receive a core intervention consisting of the OPTIMAL AYAO app and Fitbit and be randomly assigned to 4 components under consideration for inclusion in the optimized intervention: 1) general mindfulness training; 2) MVPA specific mindfulness training; 3) e-coach and 4) engagement of a buddy. We will also examine the effects of increasing MVPA on symptom burden, intensities of other activities (i.e. light and sedentary), and sleep quality and duration and potential mediators and moderators of component effects. The proposed study represents the first systematic effort to use MOST to design an optimized, scalable mHealth MVPA intervention for AYACS. This study will lead to an improved understanding of how to effectively change AYACS' MVPA and ultimately, improve health and disease outcomes in this population.