Peers Promoting Exercise Adoption and Maintenance among Cancer Survivors

摘要：研究表明，癌症幸存者采用运动可以改善他们的生活质量、情绪和疲劳。在将这些努力转化为社区环境方面做得很少。这种传播对于扩大有效干预措施的范围以改善癌症幸存者的康复和福祉至关重要。我们测试了社区同伴志愿者（特别是美国癌症协会（ACS）的RTR志愿者）为乳腺癌幸存者提供的为期3个月的电话锻炼计划的效果。这种基于理论的干预措施被成功实施，并且与接触控制条件相比，在干预后3个月和6个月时显著增加了锻炼。干预效果显著，但在6个月时减弱。坚持运动对维持心理社会益处很重要，并可能降低癌症复发的风险。维持结果对于将基于证据的行为干预措施转化为实践也是至关重要的。因此，在社区组织实施之前，我们建议加强这种干预措施，通过比较三种基于证据的社区组织可实施的维持干预措施，不仅支持锻炼的采用（3个月），还支持其在12个月的维持。在这项随机对照试验中，在RTR同行志愿者/教练进行为期3个月的电话锻炼计划后，我们将比较三组：1)Reach Plus（锻炼记录和反馈报告，但不通过电话或短信与教练进行额外联系），2)Reach Plus电话（每月教练咨询电话，锻炼记录和反馈报告），3)Reach Plus短信（每月电子邮件/短信，锻炼记录和反馈报告）。总而言之，在第4-9个月期间，三组参与者将被要求记录运动日志，并提供反馈报告；我们将通过教练每月的电话（Reach Plus电话）或电子邮件/短信（Reach Plus短信）提供进一步的支持。我们将招募150名患者，并在基线、3、6、9和12个月时评估运动（主要结局）、疲劳、生活质量和情绪。我们还将进行成本效益分析，为传播工作提供信息。如果提出的试验显示出积极的效果，我们将设计一项传播试验，采用同伴指导的方法，在社区环境中对乳腺癌幸存者进行锻炼和维持。与提供同伴指导的癌症护理组织合作，可以扩大努力的范围（“扩大规模”），以加强幸存者的康复。

DESCRIPTION (provided by applicant): Peers Promoting Exercise Adoption and Maintenance among Cancer Survivors ABSTRACT Studies in research settings have demonstrated that exercise adoption among cancer survivors can improve their quality of life, mood and fatigue. Little has been done to translate these efforts into a community-setting. Such dissemination is essential to extend the reach of efficacious interventions to improve the recovery and well-being of cancer survivors. We have tested the effects of a 3-month telephone-based exercise program offered by community peer volunteers (specifically, Reach to Recovery [RTR] volunteers of the American Cancer Society [ACS]) to breast cancer survivors. This theory-based intervention was successfully delivered and was found to significantly increase exercise at 3 months (post-intervention) and at 6 months compared to a contact control condition. Intervention effects were significant but attenuated at 6 months. Exercise maintenance is important to sustain psychosocial benefits and may reduce risk for cancer recurrence. Maintenance of outcomes is also fundamental to informing the translation of evidence-based behavioral interventions into practice. Hence, prior to implementation in community-based organizations, we propose to enhance this intervention to support not only the adoption of exercise (3 months) but also its maintenance at 12 months by comparing three evidence-based maintenance interventions that can be implemented by community-based organizations. In this randomized controlled trial, after the 3-month telephone-based exercise program from RTR peer volunteers/coaches, we will compare three groups: 1) Reach Plus (exercise logs and feedback reports but no additional contact with coaches via phone or messages), 2) Reach Plus Phone (monthly counseling calls from coaches, exercise logs and feedback reports), and 3) Reach Plus Messages (monthly email/text messages, exercise logs and feedback reports). In sum, during Months 4-9, participants in the three groups will be asked to keep exercise logs and will be provided feedback reports; extended support will be offered via monthly telephone calls from the coaches (Reach Plus Phone) or email/text messages (Reach Plus Messages). We will enroll 150 patients and assess exercise (primary outcome), fatigue, QOL and mood at baseline, 3, 6, 9 and 12 months. We will also conduct cost-effectiveness analyses to inform dissemination efforts. If the proposed trial demonstrates positive effects, we will design a dissemination trial f a peer mentored approach for exercise adoption and maintenance among breast cancer survivors in a community setting. Partnering with cancer care organizations that offer peer mentoring can expand the reach ("scale up") of efforts to enhance survivors' recovery.