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

项目总结/摘要 在美国大约有400万乳腺癌幸存者（BCS），预计这群人 在未来十年内增加100万。增加中度到剧烈强度的体力活动（MVPA）是 与治疗相关副作用、癌症复发和死亡率的降低一致相关， BCS中的QOL增加。然而，大多数BCS（约70%）不符合MVPA的建议（即，150 分钟/周）。BCS中MVPA的现有研究在很大程度上是资源密集型的，昂贵的，并且提供了多个 组件（即，指导电话、监督练习）同时限制了可扩展性。三个证据- 已经确定了可能对克服这些障碍特别有用的战略， 提高BCS的MVPA：1）MVPA计划的电子交付，2）社会支持，3）正念 训练然而，很少有人知道社会支持和正念在MVPA促进的独特作用。 为了优化干预措施，需要更多关于这些成分的离散效应的粒度信息 配置，以便最大限度地提高BCS的有效和可扩展的MVPA计划。本研究的目的 是应用多阶段优化策略（MOST），以确定哪些类型的社会支持和 正念训练干预成分在6个月的mHealth中最佳地增加和维持MVPA MVPA干预，随访6个月。MOST是一个改编自工程的框架， 有效的析因实验，以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。非活性BCS（n = 304）将 接受由Fit2ThriveMIND应用程序和Fitbit组成的核心干预，并随机分配到四个 考虑纳入优化干预的组件：1）一般正念训练; 2） MVPA特定的正念训练; 3）文本辅导; 4）好友的参与。我们亦会研究 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组分效应的潜在中介和调节剂。所有组件都具有 6-一个月的持续时间，除了文本辅导，其中将包括"助推器"个性化的个人的MVPA目标- 在6个月的随访期内实现。拟议的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BCS，包括正念 并专门测试维护策略。从这项研究中获得的知识将为发展提供信息， 更有效和可扩展的干预措施，以改善BCS中的健康和疾病结果。本研究将 提高对如何有效改变和维护BCS MVPA的理解，并告知 制定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.