Physical activity and cancer among Native American cancer survivors

缺乏运动、代谢功能障碍和几种癌症之间有很强的联系。[1-5]观察性研究表明，在癌症生存期中，体育活动可显著改善生活质量、身体功能和无病生存期，其中结直肠癌和乳腺癌的复发率可降低40%，死亡率可降低50%。[6-10]要达到这些保护作用，可能需要相对适度的体育活动，例如每天以每小时2.5英里的速度步行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的。

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.