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

项目摘要/摘要 在美国，大约有68万青少年和年轻成人癌症幸存者(AYAC)， 这一群体的存活率正在上升。AYACS经历了无数与治疗相关的有害方面 影响，更高的身体和情感问题的发生率，并处于早期发病率和 与年龄匹配的非癌症对照组的死亡率进行比较。增加中等到剧烈的体能强度 活动(MVPA)一直与提高生活质量(QOL)、减少癌症治疗- 相关副作用和慢性病风险，并改善癌症幸存者的癌症预后。然而， 大多数AYAC(~60%)不符合针对癌症的MVPA建议(即每周150分钟)，以及 关于癌症幸存者中MVPA的研究很少，专门集中在AYACS上。现有的研究成果 幸存者中的MVPA在很大程度上是资源密集型、成本高昂的，并提供多个组件(即，指导呼叫， 受监督的练习)同时限制了可伸缩性。已经确定了三种基于证据的策略 这对于克服这些障碍和提高AYACS中的MVPA可能特别有用：1)电子 提供MVPA项目，2)社会支持，3)正念训练。然而，人们对此知之甚少 社会支持和正念在MVPA推广中的独特作用。更详细的信息关于 需要这些组件的离散影响来优化干预配置，以便最大限度地提高 针对AYAC的有效且可扩展的MVPA计划。这项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 在为期12周的mHealth MVPA干预中，干预组件最佳地增加了MVPA 后续行动。MOST是一个改编自工程学的框架，它使用高效的析因实验来 评估干预组件的单独和组合影响，以确定哪些组件可以 减少、淘汰或替换以提高效率。非活动AYAC(n=304)将接受核心干预 由最优的Ayao APP和Fitbit组成，并随机分配给以下4个组件 包括在优化干预中的考虑因素：1)一般正念训练；2)MVPA特异性 专注力训练；3)电子教练；4)好友订婚。我们还将研究增加 MVPA对症状负担、其他活动(如轻度和久坐)的强度以及睡眠质量和 持续时间和潜在的成分效应的中介者和调节者。这项拟议的研究是第一次 使用MOST为AYACS设计优化的、可扩展的mHealth MVPA干预的系统性工作。这 研究将有助于更好地理解如何有效地改变AYACS的MVPA，并最终， 改善这一人群的健康和疾病结果。

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.