Project 2: Reaching Cancer Survivors with Distance-delivered Support for Physical Activity Behavior Change (REACH)

为癌症幸存者提供身体活动行为改变的远程支持 癌症是美国第二大死亡原因，导致每年超过五十万人死亡 此外，癌症幸存者更有可能患有第二种癌症，医学合并症， 生活质量下降。脆弱的癌症幸存者（例如，老年人，农村居民，服务不足）承担 癌症诊断后不成比例的痛苦负担与死亡率增加和健康状况恶化有关， well-being.运动是生存护理的一个重要方面，可以减轻这种痛苦的负担。 然而，大多数癌症幸存者没有定期锻炼，行为改变 旨在增加锻炼行为的干预措施往往达不到推荐的锻炼效果 每周进行≥ 150分钟的中等至剧烈强度运动。此外，这些干预措施 很少进行成本效益测试或转化为更广泛的使用。该提案解决了这一研究空白 通过调整BEAT癌症干预措施，已被证明在显着提高癌症发病率方面有效。 在癌症幸存者的会议演习建议，以网络为基础的交付，将增加其 传播和实施（D&I）潜力。核心干预内容（即，负责的要素 有效性测试期间确定的干预有效性）也将进行调整，以提高 不同的癌症幸存者（例如，老年人、农村居民、非洲裔美国人）。调整后的干预措施将是 这是一项名为“坚持锻炼以改善癌症幸存者健康”（REACH）的研究。6个月 然后，将在326名各种癌症的幸存者中测试REACH干预措施， 比例将是老年人，农村和少数民族。研究者将采用2组随机对照设计， 哪些幸存者将被平等分配以接受REACH或等待名单控制。我们的主要目的 将确定满足当前运动建议（≥ 150）的组间差异 ≥中等强度体力活动的每周分钟数）。我们的次要目标是 包括REACH对自我报告的身体活动和人体测量学的影响（例如，腰围）， 瘦体重、身体功能、生活质量和生物标记物（即，端粒酶[成功衰老标志物]， IFNγ [免疫状态]和高敏CRP、IL-6和IL-10 [全身炎症]）。干预成本- 并会评估成效。该提案对于改善D&I潜力和公共健康至关重要 在有效的运动行为改变计划中确定的核心干预成分对 癌症幸存者增加获得有效的运动行为改变干预措施的机会， 解决数百万癌症患者所经历的重大死亡率、合并症和心理社会负担 幸存者每年

Reaching Cancer Survivors with Distance-delivered Support for Physical Activity Behavior Change Cancer is the second leading cause of mortality in the U.S., resulting in over a half a million deaths each year. Furthermore, cancer survivors are more likely to suffer from second cancers, medical comorbidities, and reduced quality of life. Vulnerable cancer survivors (e.g., older, rural residents, underserved) bear a disproportionate burden of suffering after a cancer diagnosis related to greater mortality and poorer health and well-being. Exercise is an important aspect of survivorship care that can reduce this burden of suffering. However, the majority of cancer survivors do not engage in regular exercise, and behavior change interventions aimed at increasing exercise behavior often fall short of achieving the recommended exercise amount of ≥ 150 weekly minutes of moderate-to-vigorous intensity exercise. Moreover, such interventions are rarely tested for cost-effectiveness or translated into broader use. This proposal addresses this research gap by adapting the BEAT Cancer intervention, proven to be efficacious in significantly improving the odds of meeting exercise recommendations in cancer survivors, to web-based delivery that will increase its dissemination and implementation (D&I) potential. Core intervention components (i.e., elements responsible for intervention efficacy) identified during efficacy testing will also be adapted to improve acceptability among diverse cancer survivors (e.g., older, rural residents, African-Americans). The adapted intervention will be called Reaching out for Exercise Adherence to improve Cancer survivors' Health (REACH). The 6-month REACH intervention will then be tested in 326 survivors of a variety of cancers and in whom significant proportions will be older, rural, and minority. Investigators will employ a 2-arm randomized controlled design in which survivors will be assigned with equal allocation to receive REACH or wait-list control. Our primary aim will be to determine between-arm differences with regard to meeting current exercise recommendations (≥ 150 weekly minutes of ≥ moderate intensity physical activity) measured by accelerometer. Our secondary aims will include REACH's effects on self-reported physical activity and on anthropometrics (e.g., waist circumference), lean body mass, physical function, quality of life, and biomarkers (i.e., telomerase [marker of successful aging], IFNγ [immune status], and high sensitivity CRP, IL-6, and IL-10 [systemic inflammation]). Intervention cost- effectiveness will also be assessed. This proposal is critical to improving the D&I potential and public health impact of the core intervention components identified in an efficacious exercise behavior change program for cancer survivors. Increasing access to efficacious exercise behavior change interventions is critical to addressing the significant mortality, comorbidity, and psychosocial burden experienced by millions of cancer survivors each year.