Efficacy, effectiveness, and behavior change trials in exercise research

Abstract Background The widespread incorporation of behavioral support interventions into exercise trials has sometimes caused confusion concerning the primary purpose of a trial. The purpose of the present paper is to offer some conceptual and methodological distinctions among three types of exercise trials with a view towards improving their design, conduct, reporting, and interpretation. Discussion Exercise trials can be divided into "health outcome trials" or "behavior change trials" based on their primary outcome. Health outcome trials can be further divided into efficacy and effectiveness trials based on their potential for dissemination into practice. Exercise efficacy trials may achieve high levels of exercise adherence by supervising the exercise over a short intervention period ("traditional" exercise efficacy trials) or by the adoption of an extensive behavioral support intervention designed to accommodate unsupervised exercise and/or an extended intervention period ("contemporary" exercise efficacy trials). Exercise effectiveness trials may emanate from the desire to test exercise interventions with proven efficacy ("traditional" exercise effectiveness trials) or the desire to test behavioral support interventions with proven feasibility ("contemporary" exercise effectiveness trials). Efficacy, effectiveness, and behavior change trials often differ in terms of their primary and secondary outcomes, theoretical models adopted, selection of participants, nature of the exercise and comparison interventions, nature of the behavioral support intervention, sample size calculation, and interpretation of trial results. Summary Exercise researchers are encouraged to clarify the primary purpose of their trial to facilitate its design, conduct, and interpretation.</p

A retrospective cohort study of the influence of lifestyle factors on survival of patients undergoing surgery for colorectal cancer.

Aim: Several modifiable and non-modifiable health related behaviours are associated with the incidence of Colorectal Cancer (CRC), but there is little research on their association with survival. The project aimed to investigate possible relationships between modifiable behavioural factors and outcomes on a study cohort of CRC patients undergoing potentially curative surgery. Method: A retrospective cohort study was carried out of patients diagnosed with non-metastatic CRC undergoing elective curative surgery (January 2011 - December 2012), residing in the NHS Greater Glasgow &amp; Clyde (NHSGGC) area, UK. Data were obtained from the Scottish Cancer Registry, National Scottish Death Records. Pre-operative assessment of smoking, alcohol consumption, nurse-measured body mass index (BMI) and exercise levels were recorded and patients were followed until death or censorship. Survival analysis was carried out and proportional hazards assumptions were assessed graphically using plots and were then formally tested using the PHTEST procedure in STATA. Results: Of the initial 527 patients, 181 (34%) satisfied the inclusion criteria. The total duration of follow up was 480 person-years. At the pre-operative assessment, 75% were overweight or obese, 10.6% were current smokers, 13.1% recorded excess alcohol consumption and 8.5% had physical difficulty climbing stairs. Age, BMI, histopathological stage and physical capacity all independently affected survival (P&lt;0.05). Overweight patients (HR 2.81) and those who had difficulty climbing stairs (HR 3.31) had a significantly poorer survival. Conclusion: The study found evidence that pre-operative exercise capacity and BMI are important independent prognostic factors of survival in patients undergoing curative surgery for CRC

Changes in objectively measured activity behavior among women undergoing breast cancer treatment: Longitudinal cohort study

Purpose: Activity behaviors of breast cancer survivors (BCSs) during treatment are unlikely to be at levels sufficient enough to gain health benefits. Previous activity research among BCSs has been mainly posttreatment and generally cross-sectional. This study aimed to determine the prevalence and changes in objectively measured moderate-to-vigorous physical activity (MVPA), light physical activity (LPA), and sedentary behavior (SED) among BCSs undergoing adjuvant/palliative therapy.Methods: Participants completed baseline surveys and wore accelerometers to measure activity during waking hours during treatment and again 6 months later. Hierarchal linear modeling (HLM) was used to determine changes.Results: In total, 77 BCSs participated. Ninety-one percent provided physical activity (PA) data for 3 or more valid days at baseline (T1) and 72% at 6 months (T2); 29% met PA guidelines at T1 and 41% at T2. Daily LPA and SED did not change from T1 to T2 (133 vs 138 minutes; 595 vs 597 minutes). Controlling for body mass index at the intercept, HLM revealed that MVPA significantly increased from T1 to T2 (+5.62; P = .015).Conclusion: An increase in objectively measured total daily MVPA over 6 months was found, at which time, fewer BCSs were currently receiving chemo- or radiotherapy and may theoretically be feeling better. However, fewer T2 measures may bias and artificially inflate the results. Although total MVPA minutes increased at T2, less than half BCSs were meeting guidelines and had high amounts of LPA/SED during treatment, with insignificant change over time (71% at T1; 59% at T2). Practitioner intervention may help reduce SED while increasing LPA and MVPA behavior among those currently undergoing treatment

Age-related differences in exercise and quality of life among breast cancer survivors

Purpose: Physical activity has become a focus of cancer recovery research as it has the potential to reduce treatment-related burden and optimize health-related quality of life (HRQoL). However, the potential for physical activity to influence recovery may be age-dependent. This paper describes physical activity levels and HRQoL among younger and older women after surgery for breast cancer and explores the correlates of physical inactivity. Methods: A population-based sample of breast cancer patients diagnosed in South-East Queensland, Australia, (n=287) were assessed once every three months, from 6 to 18 months post-surgery. The Functional Assessment of Cancer Therapy-Breast questionnaire (FACTB+4) and items from the Behavioral Risk Factor Surveillance System (BRFSS) questionnaire were used to measure HRQoL and physical activity, respectively. Physical activity was assigned metabolic equivalent task (MET) values, and categorized as 3, p<0.05). Conclusions: Age influences the potential to observe HRQoL benefits related to physical activity participation. These results also provide relevant information for the design of exercise interventions for breast cancer survivors and highlights that some groups of women are at greater risk of long-term sedentary behavior

Quality of Life Changes Following Peripheral Blood Stem Cell Transplantation and Participation in a Mixed-Type, Moderate-intensity, Exercise Program

Summary:The purpose of this investigation was to evaluate the impact of undertaking peripheral blood stem cell transplantation (PBST) on quality of life (QoL), and to determine the effect of participating in a mixed-type, moderate-intensity exercise program on QoL. It was also an objective to determine the relationship between peak aerobic capacity and QoL in PBST patients. QoL was assessed via the CARES questionnaire and peak aerobic capacity by a maximal graded treadmill test, pretransplant (PI), post transplant (PII) and following a 12-week intervention period (PIII). At PII, 12 patients were divided equally into a control or exercise intervention group. Undergoing a PBST was associated with a statistically but not clinically significant decline in QoL (P<0.05). Following the intervention, exercising patients demonstrated an improved QoL when compared with pretransplant ratings (P<0.01) and nonexercising transplant patients (P<0.05). Moreover, peak aerobic capacity and QoL were correlated (P<0.05). The findings demonstrated that exercise participation following oncology treatment is associated with a reduction in the number and severity of endorsed problems, which in turn leads to improvements in global, physical and psychosocial QoL. Furthermore, a relationship between fitness and QoL exists, with those experiencing higher levels of fitness also demonstrating higher QoL.Bone Marrow Transplantation (2004) 33, 553-558. doi:10.1038/sj.bmt.1704378 Published online 12 January 200

Recovery self-efficacy and intention as predictors of running or jogging behavior: a cross-lagged panel analysis over a two-year period

Objectives: The study investigates whether two kinds of self-efficacy and intention predict regular running or jogging behavior over 2 yr. Maintenance self-efficacy refers to beliefs about one's ability to maintain a behavior, whereas recovery self-efficacy pertains to beliefs about one's ability to resume a behavior after a setback. Design and methods: Longitudinal data from runners (N=139, 80% men) were collected twice with a time gap of 2 yr. Results: Cross-lagged panel analysis revealed that recovery self-efficacy and intention jointly predicted running/jogging behavior 2 yr later, whereas running/jogging behavior did not predict recovery self-efficacy and intention. No effects of maintenance self-efficacy were found. The majority of participants (n=120) experienced at least one 2-week period of decline in running or jogging behavior. Among those who experienced lapses, recovery self-efficacy remained the only significant social-cognitive predictor of behavior. Conclusions: Recovery self-efficacy is a crucial predictor of regular running or jogging behavior over 2 yr

High dives and parallel plans: Relationships between medical student elective strategies and residency match outcomes

Background: Medical students are anxious about not getting a preferred residency position.&nbsp; We described elective patterns of two recent cohorts and examined associated match outcomes. Methods: We conducted a retrospective review of the final-year electives of all students who participated in the residency match (first iteration) at one school for 2017 and 2018.&nbsp; We categorized elective patterns and associated them with aggregated match outcomes. We examined high-demand/low-supply (HDLS) disciplines separately. Results: We described three elective patterns: High Dive, Parallel Plan(s), and No Clear Pattern. Many students had High Dive and Parallel Plans patterns; only a few showed No Clear Pattern. Match rates for High Dive and Parallel Plan patterns were high but many students matched to Family and Internal Medicine.&nbsp; When we separated out HDLS predominance, the match rate remained high but a significant number matched to disciplines in which they did not have a majority of electives. Most High Dive and Parallel Plan students who went unmatched did so with HDLS discipline electives.&nbsp; Conclusion: Many students chose High Dive and Parallel Plan strategies to both high-capacity and HDLS disciplines. Match rates were high for both patterns but students also matched to non-primary disciplines.&nbsp; Back-up planning may reside in the entire application, and not just electives selection

Diabetes NetPLAY: A physical activity website and linked email counselling randomized intervention for individuals with type 2 diabetes

<p>Abstract</p> <p>Background -</p> <p>This pilot study evaluated the feasibility (<it>recruitment, retention, adherence and satisfaction</it>) and preliminary efficacy of a 12-week website and email-linked counselling intervention on physical activity behaviour change in individuals with type 2 diabetes.</p> <p>Methods -</p> <p>A total of 49 individuals with type 2 diabetes (59% female, average age 54.1 years) were randomized to the Diabetes NetPLAY intervention or control condition. The intervention condition received information grounded in the Social Cognitive Theory (SCT), personalized weekly emails, an on-line logbook and message board. Key outcomes included physical activity behaviour and related cognition changes. The control condition was provided links to the Canadian Diabetes Association's Clinical Practice Guidelines for Physical Activity and Canada's Guide to Physical Activity.</p> <p>Results -</p> <p>Intervention participants indicated high levels of satisfaction for this mode of delivery and study results demonstrated the feasibility of web-based mediums for the delivery of physical activity information in this population. The intervention group demonstrated a significant improvement in total vigorous and moderate minutes of physical activity (p = 0.05) compared to the control group over the 12-week study. Among the SCT variables, behavioural capacity, showed a significant increase (p < 0.001) among intervention participants.</p> <p>Conclusion -</p> <p>Web-based interventions for individuals with type 2 diabetes are feasible and show promise for improving positive physical activity outcomes.</p