SEDENTARY BEHAVIOR CONTEXTS CLUSTER IN US ADULTS WITH AND WITHOUT CANCER: IMPLICATIONS FOR FUTURE INTERVENTION TARGETS

Lauren C. Bates-Fraser, Emma Cowley, Lee Stoner, FACSM, Erik D. Hanson, FACSM. The University of North Carolina Chapel Hill, Chapel Hill, NC. BACKGROUND: The average U.S adult spends most of the waking day engaging in sedentary behavior (SB), which is concerning considering the strong positive association between SB and chronic disease risk. Cancer survivors are particularly susceptible to the negative consequences of SB, considering they already have elevated chronic disease risk. To develop effective SB reduction interventions, we first need to understand the behavior. One challenge is that SB occurs in a variety of contexts, including occupational (O), transport (T), television viewing (TV), leisure time screen/computer (C), or other. The objective of this study was to investigate SB context and clustering in U.S. adults with and without cancer. METHODS: We surveyed a convenience sample of 1,588 adults (aged \u3e18 years) residing in the US from 2020-2022. Participants self-reported cancer history and SB context including O, T, TV, C, and other in hours per day for weekdays (WD-SB) and weekends (WE-SB). Z-scores were calculated for SB. Cluster analysis was conducted using a two-step method including agglomerative hierarchical clustering with squared Euclidean distance and visual inspection to identify the number of clusters followed by K-means clustering. Clusters were labeled via distinguishing SB contexts (high \u3e0.5, low: \u3c-0.5). Partial eta-squared (η2) measured effect size (small: 0.01, medium: 0.06, large: 0.14 respectively) and ANOVA was used to compare group by cluster. RESULTS: 233 cancer survivors (48 ± 19 yr., 52% female, 73% employed, 15+ cancer types) and 1,355 individuals without cancer (45 ± 18 yr., 64% female, 57% employed) completed the survey. Cancer participants engaged in 11.4 ± 6.3 WD-SB and 10.9 ± 5.6 WE-SB. Non-cancer individuals engaged in 10.6. ± 6.3 WD-SB and WE-SB. Cluster analysis identified 4 SB-context clusters with a small effect (η2: 0.01, p= 0.03). Cluster 1 served as the reference group and was characterized by the least amount of SB in all contexts (34% cancer). Cluster 2 included the most cancer survivors, exhibited high O, T, TV, C and moderate other for WD-SB and WE-SB (39% cancer, p=0.03). Cluster 3 exhibited low O, moderate T, TV, C, and high other WD-SB/WE-SB (6% cancer, p=0.03). Cluster 4 exhibited moderate O and TV and very low T, C, or other WD-SB/WE-SB (21% cancer, p=0.01). CONCLUSIONS: The largest number of cancer survivors were in the highest SB cluster across all contexts (cluster 2). However, the lowest SB cluster (cluster 1) had the second largest population of cancer survivors, suggesting some report low amounts of SB. SB context did not vary from WD to WE and cancer survivors are highly sedentary amongst all contexts. Objective accelerometry data are needed to confirm these findings. Future interventions should potentially target SB contexts most amenable to change such as TV or C because these contexts have fewer barriers to change

SEDENTARY BEHAVIOR AND CARDIOVASCULAR DISEASE RISK IN ENDOMETRIAL CANCER SURVIVORS: MODERATION BY PERCEIVED DISCRIMINATION

Grayson C. Carey, Lauren C. Bates-Fraser, Erik Hanson, FACSM, Lee Stoner, FACSM. University of North Carolina Chapel Hill, Chapel Hill, NC. BACKGROUND: Endometrial cancer (EC) survivors experience high rates of cardiometabolic comorbidities, such as obesity, and type 2 diabetes that are known risk factors of both EC and cardiovascular disease (CVD). EC survivors are also highly sedentary and engage in very low amounts of physical activity - two major CVD risk factors. EC survivors are 3 times more likely to die of CVD than their cancer. Black endometrial cancer survivors experience a 51% higher risk of overall death are more likely to die of CVD when compared to White women. This racial disparity is multifactorial as it relates to structural racism, endometrial cancer mortality, and long-term survival rates. Investigating sedentary behavior and CVD risk factors in both black and white endometrial cancer survivors may provide insight to the mortality gap impacting these women and indicate potential areas of intervention. METHODS: Endometroid Type 1 EC survivors [(n =≥10 black, n=≥ 10 white), age 50-80, with a BMI greater than 25 kg/m2] will be asked to participate in our cross-sectional study. The primary outcome of this study is carotid-femoral pulse wave velocity (cfPWV) as a measurement of CVD risk. The exposure of interest is sedentary behavior measured via accelerometry and discrimination will be measured as a moderator assessed via the perceived discrimination questionnaire. Participants will also complete the ACT-24, and HRQOL. These data will provide insight into social and environmental factors that may be influencing the overall health of the participants. Statistical procedures will include a linear mixed model with a fixed effect of sedentary behavior and random effects of CVD risk (cfPWV) with race as a moderator. ANTICIPATED RESULTS: We hypothesize that Black EC survivors will have increased cfPWV compared with White EC survivors due to increased CVD risk and structural racism. There is a critical need to identify modifiable CVD risk factors in EC survivors leading to the development of future interventions targeting these behaviors. These data will be used to investigate how perceived discrimination may influence CVD risk and EC’s subsequent activity behaviors

IMPACT OF PRIOR AEROBIC EXERCISE ON ARTERIAL STIFFNESS DURING PROLONGED SITTING IN ACTIVE HEALTHY ADULTS

Daniela Paz, Sasha Riley, Erik Hanson, FACSM. University of North Carolina Chapel Hill, Chapel Hill, NC. BACKGROUND: It is well established that sedentary behavior (SB) increases the risk of cardiovascular disease (CVD), which is the leading cause of death annually. Acute bouts of prolonged sitting have been shown to increase arterial stiffness (AS) which is an independent risk factor for CVD. Currently, the use of sitting interruption strategies has produced mixed results. One option that has shown promising results in decreasing AS is an acute bout of aerobic exercise. However, it is unknown if aerobic exercise is a strong enough stimulus to attenuate increases in AS across a prolonged sitting bout. Therefore, the purpose of this study is to evaluate the effects of prolonged sitting with and without a prior bout of moderate-intensity aerobic exercise on brachial-femoral (bfPWV) pulse wave velocity and on femoral-ankle (faPWV) pulse wave velocity. METHODS: In the spring of 2022, 22 healthy, active adults (18-35 yrs) will be recruited. They will undergo a randomized crossover design with two experimental conditions, exercise (EX) and standing (STAND), preceded by a familiarization visit. Participants will report back to lab between 1-7 days after the familiarization visit for their first experimental visit and 2-7 days after that for their second experimental visit. For the experimental visit, participants will consume a protein bar two hours prior to the start of the visit to reduce hunger distractions. Participants will then undergo baseline measures of bfPWV and faPWV in a supine position followed by 30 minutes of brisk walking (X-Y% of heart rate reserve) followed by 5 minutes of standing (EX), or 35 minutes of standing (STAND) depending on the condition. Participants will then complete a 2-hour uninterrupted sitting bout. During this time the participant will sit quietly with their knees at a 90-degree angle while performing desk work. BfPWV and faPWV measures will be repeated pre- and post-sitting. The effects of prolonged sitting on AS with and without prior aerobic exercise will be analyzed using a linear mixed model. ANTICIPATED RESULTS: It is hypothesized that performing an acute aerobic exercise bout will attenuate the increases in brachial-femoral and femoral-ankle PWV over a prolonged sitting bout

SEDENTARY BEHAVIOR INTERRUPTION PRESCRIPTION IN MIDDLE- & OLDER-AGED ADULTS: IDENTIFYING THE OPTIMAL DOSE

Margaret I. Damare, Lauren C. Bates-Fraser, Emma S. Cowley, Erik Hanson, FACSM, Lee Stoner, FACSM. University of North Carolina at Chapel Hill, Chapel Hill, NC. BACKGROUND: Middle-aged and older adults reportedly engage in high amounts of prolonged sedentary behavior (SB, ≤1.5 METs in seated/reclined posture). Prolonged SB is associated with increased arterial stiffness (AS), a measure of cardiovascular disease (CVD) risk. Current U.S. recommendations for SB interruption are broad, and limited to the adage “sit less, move more.” Thus, the proposed study aims to identify a suitable (feasible and effective) modality (walking or pedaling) for SB interruption in adults ≥45 years at risk for CVD. METHODS: The proposed randomized controlled cross-over trial will recruit 20 participants (male and female ≥45) with ≥2 CVD risk factors. Participants will complete three experimental lab visits, an exit interview, and an ecological momentary assessment (EMA). Each experimental condition will include 2.5 hrs sitting with (WALK, PEDAL) or without (CON) interruptions. During experimental visits, sitting will be interrupted at the midpoint of each hour with 5 mins of standing, and at the end of each hour with 5 mins of walking or pedaling (under-desk elliptical). The primary outcome of the study will be global (carotid-femoral, brachial-femoral, femoral-ankle) pulse wave velocity. Compared to segmental measures of PWV, global-PWV allows for more comprehensive evaluation of impacts that prolonged SB and proposed interruptions may have on CVD risk. The aim will be tested using a time (PRE, POST) by condition (CON, WALK, PEDAL) mixed effects model. ANTICIPATED RESULTS: Findings from this study will identify whether one or both modalities (walking and/or pedaling) effectively mitigate the increase in AS associated with prolonged sitting. Participant feedback (exit interview) and real-time movement behavior (EMA) will provide qualitative information to facilitate development of population-specific recommendations for SB interruption in adults at high risk for CVD

QUALITY OF LIFE AND FATIGUE DECREASE WITH THE INITIATION OF ANDROGEN RECEPTOR SIGNALING INHIBITORS FOR THE TREATMENT OF ADVANCED PROSTATE CANCER

BACKGROUND: Quality of life (QoL) is a key patient reported outcome that can be tracked during prostate cancer (PC) treatment and in response to interventions. It is well-established testosterone suppression for localize PC adversely impacts QoL, although far less is known during advanced disease. Cross-sectional studies suggest that men with metastatic PC being treated with androgen receptor signaling inhibitors (ARSI) have lower QoL. However, the rate of change in QoL remains unclear and to what extent of the decline is due to ARSI treatment. This 12-week observational pilot study aimed to determine longitudinal changes in QoL following the initiation of ARSI treatment. Changes in fatigue, depression and anxiety were also examined. METHODS: Men with advanced PC (n=6, 70±9 y, 30.1±3.5 kg/m2 BMI) initiating ARSI completed testing at baseline and after 12 weeks of follow up. The majority (66.7%) of men were diagnosed with castration-sensitive metastatic PC. QoL was the primary outcome and was assessed using the functional assessment of cancer treatment-prostate (FACT-P). The minimal clinically important change (MCID) for FACT-P is 6-10 points. Fatigue was assessed using the Functional Assessment of Chronic Illness Therapy (FACIT-F), with a MCID of 3 points. Depression and anxiety were assessed using the Hospital Anxiety and Depression Score (HADS). Mean differences (MD) were calculated as 12-week follow-up - baseline and effect sizes are presented as Cohen’s D (d). RESULTS: QoL from baseline to 12-weeks revealed worsening change that approached significance (MD= -11.8, 95% CI -21.0, -2.5, d=1.01; p= 0.056) but exceeded the MCID. There was a non-significant decrease (worsening) for fatigue (MD=-4.0, 95% CI -8.0, 0.1, d=0.779; p=0.115) that also exceeded the MCID. Fatigue and QoL also revealed a strong correlation (r=0.732, p=0.007). There were no changes in anxiety and depression scores (MD=1.2, 95% CI -0.6, 3.0, d=0.523; p=0.256). CONCLUSIONS: In support of cross-sectional studies, these preliminary results suggest that 12 weeks of ARSI lead to clinically important decreases with large effect sizes in both QoL and fatigue during advanced PC treatment. Interventions that can minimize fatigue may lead to improvements in QoL. Longer follow up studies (i.e., 24 weeks) and larger sample sizes are required to confirm these initial findings

PHYSICAL FUNCTION CHANGES FOLLOWING 12 WEEKS OF ANDROGEN RECEPTOR SIGNALING INHIBITORS FOR ADVANCED PROSTATE CANCER

BACKGROUND: Cross-sectional studies indicate that men with metastatic prostate cancer (PC) using androgen receptor signaling inhibitors (ARSI) have lower physical function (PF). However, the rate of change in PF remains unclear. This observational pilot study aimed to longitudinally examine objectively measured PF in men with advanced PC initiating ARSI treatment and after 12 weeks of therapy. Additionally, changes in grip strength, muscular power, and balance were determined. METHODS: Men with advanced PC (n=6, 70±9 y, 30.1±3.5 kg/m2 BMI) initiating ARSI completed testing at baseline and 12 weeks later. The majority (66.7%) of men were diagnosed with castration-sensitive metastatic PC. The primary outcome was PF, assessed using short physical performance battery [SPPB], timed up and go [TUG], and 400m walk. Secondary outcomes included grip strength (handgrip dynamometry), power (GymAware sit-to-stand power test mean and peak power) and balance (Sensory Organization Test composite score; somatosensory, visual, and vestibular ratios). Mean differences (MD) were calculated as 12-week follow-up - baseline. RESULTS: From baseline to 12 weeks of ARSI, there was a 4% improvement in 400m walk that approached significance [MD: -13 s; 95% CI (-25, -1); p=0.082, d=0.88]. However, there were no differences in PF as assessed by SPPB [MD: 0.33 points; 95% CI (-0.49, 1.16); p=0.465, d=0.32] and TUG [MD: -0.6 s; 95% CI (-1.4, 0.2); p=0.186, d=0.62]. For the secondary outcomes, there was a 9% decline in peak power [MD: -70.5 W; 95% CI (-124, -17.2); p=0.049, d=1.06]. However, there were no declines in mean power [MD: -18.7 W; 95% CI (-50.7, 13.4); p=0.305, d=0.47], grip strength [MD: -1.7 kg; 95% CI (-3.6, 0.2); p=0.149, d=0.70], or balance (composite score [MD: 0.2 pt; 95% CI (-6.2, 6.6); p=0.961, d=0.02], somatosensory ratio [MD: 1.3 pt; 95% CI (-2.4, 5.0); p=0.512, d=0.29], visual ratio [MD: 7.5 pt; 95% CI (-2.5, 17.5); p=0.203, d=0.60], and vestibular ratio [MD: 5.7 pt; 95% CI (-6.8, 18.2); p=0.416, d=0.36]). CONCLUSIONS: Contrary to prior cross-sectional studies, these preliminary results suggest that 12 weeks of ARSI do not adversely affect objectively measured PF. However, peak muscular power demonstrated a decline of large effect, which warrants further investigation as muscular power is closely linked with PF. Longer follow up (i.e., 24 weeks) and larger sample sizes are required to confirm these initial findings

THE EFFECT OF CARBON-PLATED RUNNING SHOES ON PERFORMANCE

Dominic Collichio1, Kyle Edgar1, Erik Hanson, FACSM1, Claudio Battaglini, FACSM1, Mark Belio1, Lilly Niehaus1, Zack Bennett1, Brian Jensen1, Benjamin Gordon2. 1UNC, Chapel Hill, NC. 2University of Pittsburgh, Pittsburgh, PA. Purpose: The purpose of this study was to determine the effects of a carbon fiber plate on running economy (RE) in commercially available shoes of nearly identical midsole composition, geometry, and stack height. Three running shoes were compared; a traditional running shoe, no carbon plate, Razor 3 (R3), a half carbon plated shoe Razor Speed Elite Hyper (SE), and a full carbon plated shoe, Nike Vaporfly (VF). Methods: Nine male participants (18-35 years old) who had completed a 5 Km run in under 18 minutes and no injury or training disruption within a 6-month period of participation completed this 3-visit study. Participants completed a familiarization session, followed by a second visit in which a VO2max test was performed to determine ventilatory threshold (VT). Visit three included a shoe comparison of three different shoes running on a treadmill at a prescribed intensity: 5-10%% above and below VT for a total of six running bouts. Data were collected on VO2, RPE, shoe comfort, and running economy. Data were analyzed using a linear mixed model. Results: When comparing SE vs. R3, the carbon fiber plate did not change RE, when running at intensities below (p = 0.355) and above VT (p = 0.715). There were no differences in heart rate (HR) and rating of perceived exertion (RPE) in either the R3 (p = 0.875) or VF (p = 0.054) relative to the SE when performing below VT. However, relative to the SE, the VF showed a 2.8 % and 1.6% improvement in RE below (p = 0.005) and above VT (p = 0.019) respectively. The main effect of running intensity (above vs. below VT) was observed for VO2 (p \u3c 0.001) and HR (p \u3c 0.001). R3 remained unchanged independent of running speed relative to the SE (p = 0.827), while RE in the VF was increased (p = 0.046). No shoe condition x speed interaction was observed for HR (p = 0.323) or RPE (p = 0.125). Conclusion: The current findings of this study suggest that a carbon fiber plate alone may not account for RE improvements but play a contributory role in racing. While not statistically significant, the SE may provide physiologically significant improvements at faster running speeds. The current study is ongoing, and additional data are necessary to determine the true benefit or lack thereof of a carbon fiber plate on performance metrics