Physical activity and cancer among Native American cancer survivors

缺乏体力活动、代谢功能障碍和几种癌症之间有很强的相关性。[1-5]观察性研究表明，在癌症存活者中，体力活动可以显著提高生活质量、身体功能和无病存活率，[6]包括结直肠癌和乳腺癌的复发减少40%，死亡率降低50%。[6-10]可能需要相对适量的体力活动来实现这些保护作用，例如每天以大约2.5英里的时速步行30分钟。[9，11]然而，这些研究都不是针对美洲原住民癌症幸存者。 纳瓦霍人是亚利桑那州和美国最大的美洲原住民群体，其5年癌症存活率是全国最低的。[12]考虑到纳瓦霍人在亚利桑那州的高代表性、代谢功能障碍的不成比例的负担、癌症发病率的上升[14]以及癌症确诊后的不良结局和存活率，提高纳瓦霍人的癌症存活率非常重要。[15]很少有研究研究纳瓦霍人癌症幸存者的体力活动干预对身体健康、生活质量或代谢功能的生物标记物的影响。美洲原住民癌症预防伙伴关系(NACP)提供独特的以社区为基础的领导和指导，以解决美洲原住民中癌症的生存问题，并根据社区的信仰和需求定制以身体活动为基础的健康促进倡议。这项拟议的试点研究是亚利桑那大学癌症中心、北亚利桑那大学和亚利桑那州肿瘤协会-弗拉格斯塔夫共同努力的结果。学术、临床和社区合作伙伴之间的这种伙伴关系是一个为期三年的项目的基础，该项目包括1)对身体活动习惯、障碍和偏好的定性评估，包括对针对非土著癌症幸存者的现有体育活动计划的态度评估；以及2)利用定性信息开发和测试干预措施，以提高纳瓦霍癌症幸存者的身体健康和生活质量。具体目标是： 目标1：使用焦点小组和个人访谈评估纳瓦霍癌症幸存者目前的体育活动习惯、障碍和偏好(阶段1)： 1.1.评估当前的体育活动习惯和进行适当体育活动的潜在障碍。 1.2.评估体力活动偏好，借助参与者对现有计划的审查，为纳瓦霍癌症幸存者制定量身定制的体力活动干预措施。 目的2：评估在纳瓦霍癌症幸存者中对身体健康和生活质量进行文化敏感和临床适当的体力活动干预的可行性和有效性(阶段2)： 2.1通过与已知可减少新癌症复发和发展的体力活动水平相一致的保留率、满意度和依从性的测量，评估文化敏感和临床适当干预措施的可行性。 2.1评估基于文化敏感和临床适当的体力活动干预对身体健康(有氧能力)和生活质量的主要结果的影响。

There is a strong association between physical inactivity, metabolic dysfunction and several cancers.[1-5] Observational studies have demonstrated that physical activity in cancer survivorship can lead to significantly improved quality of life, physical function, and disease free survival,[6] including up to 40% reduction in recurrence and up to 50% reduction in mortality of colorectal and breast cancer.[6-10] Relatively moderate amounts of physical activity may be needed to achieve these protective benefits, such as walking 30 minutes per day at about 2.5 miles per hour.[9,11] None of these studies, however, were focused on Native American cancer survivors. Navajo are the largest group of Native Americans in Arizona and the U.S. and have the poorest 5-year cancer survival rate of any group in the country.[12] Improving cancer survivorship among the Navajo is important given the high representation of Navajo in Arizona, the disproportionate burden of metabolic dysfunction,[13] rising cancer rates[14] and the poor outcomes and survival after cancer diagnosis.[15] Little research has examined the effects of physical activity interventions for Navajo cancer survivors on physical fitness, quality of life, or biomarkers of metabolic function. The Partnership for Native American Cancer Prevention (NACP) provides unique community-based leadership and guidance to address cancer survivorship among Native Americans and to tailor physical activity-based health promotion initiatives to community beliefs and needs. This proposed pilot study is a collaborative effort between the University of Arizona Cancer Center, Northern Arizona University, and Arizona Oncology Associates-Flagstaff. This partnership between academic, clinical and community partners serves as the foundation for a three-year project including 1) a qualitative assessment of physical activity habits, barriers, and preferences, including an evaluation of attitudes towards existing physical activity programs aimed at non-Native cancer survivors; and 2) use of the qualitative information to develop and test an intervention to increase physical fitness and improve quality of life of Navajo cancer survivors. The specific aims are: AIM 1: Assess current physical activity habits, barriers, and preferences among Navajo cancer survivors using focus groups and individual interviews (Phase 1): 1.1. Assess current physical activity habits and potential barriers to engaging in adequate physical activity. 1.2. Assess physical activity preferences, aided by participant review of existing programs, for development of a tailored physical activity intervention for Navajo cancer survivors. AIM 2: Evaluate the feasibility and effectiveness of a culturally sensitive and clinically appropriate physical activity intervention among Navajo cancer survivors on physical fitness and quality of life (Phase 2): 2.1 Evaluate the feasibility of a culturally sensitive and clinically appropriate intervention by measures of retention, satisfaction, and adherence consistent with levels of physical activity known to reduce recurrence and development of new cancers. 2.1 Evaluate the effect of a culturally sensitive and clinically appropriate physical activity based intervention on primary outcomes of physical fitness (aerobic capacity) and quality of life.