Fit2ThriveMIND: Optimizing a mHealth Physical Activity Intervention with Mindful Awareness Lessons in Breast Cancer Survivors

项目摘要/摘要 美国约有400万乳腺癌幸存者(BC)，预计这一人口将 在未来十年内增加100万。增加中等到剧烈的体力活动(MVPA)是 持续减少与治疗相关的副作用、癌症复发和死亡率，以及 提高BCS患者的生活质量。然而，大多数BCS(~70%)不符合MVPA建议(即150 分钟/周)。现有关于BCS中MVPA的研究主要是资源密集型、成本高昂且可提供多个 组件(例如，指导呼叫、受监督的练习)同时限制了可伸缩性。三个证据- 已经确定了可能对克服这些障碍特别有用的基于策略 在BCS中增加MVPA：1)MVPA计划的电子交付，2)社会支持，3)正念 训练。然而，人们对社会支持和正念在MVPA推广中的独特作用知之甚少。 需要有关这些组件的离散影响的更细粒度信息来优化干预 配置，以最大限度地提高针对BCS的有效且可扩展的MVPA计划。这项研究的目的 是应用多阶段优化策略(MOST)，以确定哪些类型的社会支持和 正念训练干预组件在6个月的mHealth中最佳地增加和维持MVPA MVPA干预，随访6个月。MOST是一个改编自工程学的框架，它高度使用 有效的析因实验来评估干预成分的单独和组合效应 确定哪些可以减少、消除或替换以提高效率。非活动BCS(n=304)将 接受由FIt2ThriveMinD应用程序和Fitbit组成的核心干预，并被随机分配到四个 考虑纳入优化干预的组成部分：1)一般正念训练；2) 专门针对MVPA的正念训练；3)文字指导；4)朋友的参与。我们还将研究 增加MVPA对症状负担、其他强度活动(即轻度和久坐)和睡眠的影响 质量和持续时间以及潜在的成分效应的调解者和调节者。所有具有的组件都具有 为期6个月，但短信辅导除外，其中将包括针对个人MVPA目标个性化的“助推器”- 在6个月的随访期内达到。这项拟议的研究是第一次系统地努力 使用MOST设计包含正念的优化、可扩展的mHealth MVPA BCS干预 并专门测试维护策略。从这项研究中获得的知识将为发展 更有效和可扩展的干预措施，以改善BCS的健康和疾病结局。这项研究将 提高对如何有效地更改和维护BCS的MVPA的理解，并告知 开发更有效和可扩展的干预措施，以改善健康和疾病结果 BCS。

PROJECT SUMMARY/ABSTRACT There are approximately 4 million breast cancer survivors (BCS) in the U.S., and this population is expected to increase by 1 million in the next ten years. Increased moderate-to-vigorous intensity physical activity (MVPA) is consistently associated with reductions in treatment-related side effects, cancer recurrence and mortality, and increased QOL in BCS. Yet, the majority of BCS (~70%) do not meet MVPA recommendations (i.e., 150 mins/week). Existing studies of MVPA in BCS 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 BCS: 1) electronic delivery of a MVPA program, 2) social support, and 3) mindfulness training. However, little is known about 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 BCS. 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 and maintain MVPA in a 6-month mHealth MVPA intervention with a 6-month 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 BCS (n=304) will receive a core intervention consisting of the FIt2ThriveMIND app and Fitbit and be randomly assigned to four components under consideration for inclusion in the optimized intervention: 1) general mindfulness training; 2) MVPA-specific mindfulness training; 3) text-coaching; and 4) engagement of a buddy. We will also examine the effects of increasing MVPA on symptom burden, other intensity activities (i.e. light and sedentary), and sleep quality and duration and potential mediators and moderators of component effects. All components with have a 6-month duration except text coaching which will include “boosters” personalized to an individual's MVPA goal- attainment during the 6-month follow-up period. The proposed study represents the first systematic effort to use MOST to design an optimized, scalable mHealth MVPA intervention in BCS that incorporates mindfulness and specifically tests a maintenance strategy. Knowledge gained from this study will inform the development of more effective and scalable interventions to improve health and disease outcomes among BCS. This study will lead to an improved understanding of how to effectively change and maintain BCS' MVPA and inform the development of more effective and scalable interventions to improve health and disease outcomes among BCS.