Examination of 24-hour movement behaviors in home vs. office work locations

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NEGATIVE 24-HOUR MOVEMENT BEHAVIORS IN CANCER POPULATIONS: CLUSTERING OF PHYSICAL ACTIVITY, SEDENTARY BEHAVIOR, AND SLEEP

Lauren C. Bates, Gabriel Zieff, Lee Stoner, FACSM, Erik D. Hanson, FACSM. The University of North Carolina Chapel Hill, Chapel Hill, NC. BACKGROUND: Movement behaviors (MB) across the 24-hour day, including physical activity, sedentary behavior (SB), and sleep, have important health implications. The objective of this study was to examine the clustering of MBs to analyze its association with cancer. METHODS: In December 2020, we surveyed a convenience sample of 746 adults (aged \u3e 18 years) residing in USA. Participants self-reported moderate-to-vigorous physical activity (MVPA), SB, sleep, and cancer history. Z-scores were calculated for weekday (WD) SB, weekend (WE) SB, MVPA, and sleep. 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 MBs z-scores (high: \u3e 0.5, low: \u3c -0.5). Partial eta-squared (ŋ2) measured effect size (small: 0.01, medium: 0.06, large: 0.14, respectively) and ANOVA was used to compare group by cluster. RESULTS: 112 cancer participants (40 ± 14 yr., 45% female, 64% employed, 15+ cancer types) and 634 non-cancer participants (38 ± 15 yr., 61% female, 62% employed), with matched socio-economic factors, participated in the study. Cluster analysis identified five MB clusters (ŋ2:0.054, p\u3c0.001). Cluster 2 was characterized by high SB, very low MVPA, and very low sleep and had the most cancer participants (31% cancer). Three other clusters had significantly fewer cancer participants. Cluster 1 was characterized by low SB, low MVPA, low sleep (p=0.002, 16% cancer). Cluster 3 was characterized by high SB, some MVPA, high sleep (p\u3c0.001, 11% cancer). Cluster 4 was characterized by high WD SB, low WE SB, low MVPA, high sleep (p\u3c0.001, 10% cancer). Finally, cluster 5 was characterized by no SB, high MVPA, some sleep (p=0.070, 19% cancer) which tended to have fewer cancer participants. CONCLUSIONS: Lifestyle behaviors tend to cluster. Five 24-hour MB clusters were identified, with the largest number of cancer patients (31%) present in the most negative cluster (high SB, very low MVPA, and very low sleep). Considering negative MBs contribute to increased risk of cancer recurrence and adverse health outcomes, future research is warranted to identify feasible lifestyle interventions strategies targeting these co-occurring behaviors

BLOOD FLOW RESTRICTED EXERCISE DOSAGE FOR CHRONIC KIDNEY DISEASE UNDERGOING HEMODIALYSIS: A META-ANALYSIS PROPOSAL

Alexander G. Kasari, Lauren C. Bates-Fraser, Erik D. Hanson, FACSM, Lee Stoner, FACSM. University of North Carolina at Chapel Hill, Chapel Hill, NC. BACKGROUND: Chronic kidney disease (CKD) affects millions of adults. To combat CKD, patients will undergo hemodialysis treatment. Exercise prescription is a useful adjuvant therapy. However, as a function of hemodialysis and CKD risk factors, traditional exercise is not feasible for all patients. A potential alternative to standard exercise prescription is blood flow restricted exercise (BFR-E). BFR-E can be completed at lower intensity and duration than conventional exercise. However, the optimal BFR-E dosage (frequency, intensity, duration, and modality) is unknown. The objective of this meta-analysis is to determine which BFR-E optimally improves health outcomes in patients with CKD receiving hemodialysis. METHODS: Following PROSPERO registration, a systematic review and meta-analysis will be conducted. Articles will be identified through using electronic databases. Inclusion criteria includes: (i) adult patients (age: 18 years or older) from stage 1 of CKD (Glomerular filtration rate (GFR) \u3e 90 mL/min) to stage 5 (GFR \u3c 15 mL/min); (ii) patients undergoing home or in-center hemodialysis treatment and; (iii) randomized controlled trials incorporating BFR-E (either aerobic or resistance training) and control groups or cross-sectional study designs will be included. Patients performing BFR-E while undergoing peritoneal dialysis will be excluded. Studies will also be evaluated on their quality using the RoB2 Cochrane risk-of-bias tool. ANTICIPATED RESULTS: Investigating dosage of BFR-E will allow us to consolidate existing evidence of variable BFR-E protocols to fill a critical gap in the literature describing recommended intensity, frequency, duration, and modality of BFR-E. Research into BFR-E will shape recommendations for patients’ exercise regimens and help generate a strategic course of action to delay the progression of CKD

FEASIBLE SEDENTARY BEHAVIOR SUBSTITUTION STRATEGIES TO REDUCE CARDIOVASCULAR DISEASE RISK IN ENDOMETRIAL CANCER SURVIVORS

Margaret I. Damare, Lauren C. Bates, Erik D. Hanson, FACSM, Lee Stoner, FACSM. University of North Carolina at Chapel Hill, Chapel Hill, NC. BACKGROUND: Among endometrial cancer (EC) survivors, the major cause of death is cardiovascular disease (CVD). Factors contributing to the heightened CVD risk include the cancer treatment and lifestyle behaviors. Conversely, CVD risk can be decreased through engagement in healthy lifestyle behaviors. Sedentary behavior (SB, ≤1.5 METs in seated/reclined position) reduction may be a feasible target for decreasing CVD risk in EC survivors. EC survivors have been reported to engage in high amounts of SB, a behavior which strongly associated with CVD mortality and morbidity. However, it is unknown what type and dose of SB interruption will be most feasible for EC survivors. Therefore, this study will investigate simple strategies to substitute SB (standing or walking) in EC survivors to investigate which type and dose reduces CVD burden associated with sitting. METHODS: The proposed randomized, controlled cross-over trial will recruit 20 EC survivors aged ≥50 years. Subjects will complete three SB conditions each lasting 2.5 hours. Two substitution conditions will interrupt sitting for 5 mins/hour via standing or walking because these are simple, cost-effective, potentially feasible strategies in real-world settings. The control condition will be uninterrupted SB. The primary outcome will be aortic arterial stiffness, measured using carotid-femoral pulse wave velocity (cfPWV) The cfPWV is the gold-standard noninvasive measure of CVD risk and has been reported to acute increase with exposure to prolonged sitting. Changes in cfPWV across the three conditions will be compared using a mixed model, with subject specified as random and time and condition as fixed effects. ANTICIPATED RESULTS: We anticipate that the findings of this study will facilitate the development of a feasible (low-cost and simple) and effective SB substitution recommendation for EC survivors. The findings will guide the development of an interventional study to test our recommended SB substitution strategy in EC survivors in the real-world

24-HOUR ACTIVITY BEHAVIORS IN KIDNEY CANCER PATIENTS AND SURVIVORS

Kailyn Lowder1, Lauren C. Bates-Fraser1,2,3, Lee Stoner1,2,4, FACSM, Erik D. Hanson1,2,3, FACSM 1. Department of Exercise and Sport Science. The University of North Carolina at Chapel Hill, Chapel Hill, NC. 2. Department of Allied Health Science. The University of North Carolina at Chapel Hill 3. Lineberger Comprehensive Cancer Center. The University of North Carolina at Chapel Hill 4. Department of Epidemiology. The University of North Carolina at Chapel Hill BACKGROUND: Kidney cancer (KC) is the 10th most common cancer in the US, but given its 93% 5-year survival rate, there needs to be more emphasis on reducing chronic disease risk (i.e., cardiometabolic health) in the surviving population. Chronic disease risk may be mitigated through prescribing healthy 24-hour activity behaviors (24-AB), defined as sedentary (SB), moderate to vigorous physical activity (MVPA), and sleep behaviors over 24-hr. The objective of this study is to investigate 24-AB in KC survivors compared to survivors of other cancer types to identify future intervention targets specific to KC survivors. METHODS: From 2020-2022, we recruited an online convenience sample of 15 KC survivors (42 ± 18 years, 74% non-Hispanic, 87% white, 87% college degree, 47% income \u3c$50,000) and 186 mixed-type cancer survivors (48 ± 19 years, 87$50,000). Participants self-reported 24-AB, including weekday SB (WD-SB), weekend SB (WE-SB), moderate-to-vigorous physical activity (MVPA), and sleep. A one-way ANOVA was used to compare 24-hour movement behaviors between KC survivors and mixed type survivors. Significance was set at p=0.05 and mean differences are reported. Cohen’s d was calculated to determine effect size determined as small (0.2), medium (0.5), and large (0.8). RESULTS: KC survivors reported significantly more WD-SB (3 hours, d=0.56, p = 0.02) and WE-SB (3 hours, d=0.69, p = 0.01) with medium effect sizes compared to mixed-type cancer survivors. There were no significant differences in MVPA (d=0.01) or sleep (d=0.44) between KC survivors and mixed type survivors (p \u3e 0.05) with small and medium effect sizes respectively. CONCLUSIONS: KC survivors spend most of their time sitting and spend very minimal time being physically active, as they are not meeting recommended ACSM guidelines for MVPA, thus increasing their chronic disease risk. Compared to mixed-type cancer survivors, KC survivors engage in significantly more WD-SB and WE-SB. Therefore, future interventions aiming to improve 24-AB for KC survivors should target SB, however further research is needed to confirm these data with objective accelerometry data

24-HOUR ACTIVITY BEHAVIORS IN LUNG CANCER PATIENTS AND SURVIVORS

Robert M. Czyzewski (1), Lauren C. Bates-Fraser (1,2,3), Lee Stoner (1,2,4), FACSM, Erik D. Hanson (1,2,3), FACSM. University of North Carolina at Chapel Hill, Chapel Hill, NC. Background: Lung cancer is the second most common cancer with the American Cancer Society estimating 236,740 new cancer cases this year. The number of lung cancer deaths are declining annually due to advancements in screening and treatment. However, there is limited literature regarding 24-hour activity behaviors including sedentary behavior (SB), moderate to vigorous physical activity (MVPA), and sleep. Healthy 24-hour activity behaviors contribute to secondary disease prevention and could be important potential intervention targets to improve lifestyle and quality of life in lung cancer patients and survivors. Therefore, the primary aim of the study was to investigate 24-hour activity behaviors in lung cancer patients and survivors. Methods: From 2020-2022, we recruited an online convenience sample of 14 participants with patients (49 ± 14 years, 82% non-Hispanic, 91% White, 91% college degree, 45% household income0.05). Conclusion: Although none of these participants are meeting the guidelines for MVPA set by the American College of Sports Medicine, the stark contrast in MVPA between patients and survivors suggest that treatment intensity may contribute to reduced MVPA. There are no differences in high levels of SB and participants are achieving recommended sleep. These preliminary data suggest survivorship interventions targeting SB reduction are needed for lung cancer patients and survivors. Funding: The University of North Carolina’s University Cancer Research Fund provided funding for data collection

24-HOUR ACTIVITY BEHAVIORS AMONG CANCER SURVIVORS DURING AND FOLLOWING COVID-19

Graceanne Boone, Lauren C. Bates-Fraser, Lee Stoner, FACSM, Erik D. Hanson, FACSM. The University of North Carolina at Chapel Hill, Chapel Hill, NC. BACKGROUND: The COVID-19 pandemic in 2020 caused widespread social restrictions in an attempt to mitigate transmission. These restrictions impacted 24-hour activity behaviors (24-AB), including moderate to vigorous physical activity (MVPA), sedentary behavior (SB), and sleep. The objective of this study was to determine change in 24-AB from during- (2020) to post- (2021 and 2022) pandemic among breast- (BC) and mixed type-cancer survivors. METHODS: From 2020-2022, we recruited a U.S. nationwide convenience sample of 46 BC (52 ± 21, 87% non-Hispanic, 78% white) and 238 mixed type cancer survivors (45 ± 18, 81% non-Hispanic, 76% white). Participants self-reported weekday SB (WD-SB), weekend SB (WE-SB), MVPA, and sleep in hours (hr.) or minutes (min) per day. A repeated measures ANOVA was used to determine the time effect and to compare 24-AB between BC and mixed type cancer survivors. Significance was set at p=0.05 and mean differences are reported. RESULTS: Overall, when comparing 24-AB by year between BC and mixed type cancer survivors, there were statistically significant differences in WD-SB, WE-SB, MVPA, and sleep (all p \u3c0.001). From 2020 to 2022, WD-SB (5.1 ± 18.3 hr.) and WE-SB (4.2 ± 16.8 hr.) decreased while MVPA (144 ± 269 min) and sleep (0.4 ±1.4 hr.) increased in BC and mixed type cancer survivors with no group differences. CONCLUSION: Among cancer survivors, 24-AB have improved from 2020 to 2022 with reduction in WD-SB and WE-SB and increases in MVPA and sleep. Furthermore, there were no significant differences in 24-hour activity behaviors in BC compared to mixed type cancer survivors. Further research is needed to confirm these data with objective accelerometry data. However, cancer survivors would benefit from continued improvements in 24-AB especially targeting the high amounts of WD-SB and WE-SB. Interventions targeting 24-AB should also be robust enough to withstand potential future pandemics and associated social restrictions or at least consider alternative approaches such as virtual delivery to avoid the significantly worse 24-AB reported in 2020 at the onset of the COVID-19 pandemic

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

24-HOUR ACTIVITY BEHAVIOR INVESTIGATION IN WHITE AND BLACK ENDOMETRIAL CANCER POPULATIONS

Caroline Inga Shealy, Lauren C. Bates-Fraser, Lee Stoner, FACSM, Erik D. Hanson, FACSM. University of North Carolina at Chapel Hill, Chapel Hill, NC, NC. Background: Endometrial cancer (EC) is the most common cancer of the female reproductive organs affecting over 66,000 US women annually. EC is more common in White women, but mortality is higher in Black women. EC survivors experience a 3-6-fold greater risk for cardiovascular disease (CVD) compared to the general population. Poor 24-hour activity behaviors including sedentary behavior, physical inactivity, and sleep, contribute to CVD risk. The primary aim of the study was to investigate 24-hour activity behaviors in Black and White EC. A secondary aim was to explore differences between 2020 and subsequent years due to restrictions associated with the COVID-19 pandemic. Methods: From 2020-2022, we recruited an online convenience sample of 14 EC with 9 self-identifying as White (43 ±22 years, 55% college degree, 78% household income \u3c$50,000, 89$50,000, 60% full-time employment). Participants self-reported 24-hour activity behaviors including weekday SB (WD-SB), weekend SB (WE-SB), moderate-to-vigorous physical activity (MVPA), and sleep. An independent samples t-test was used to compare 24-hour movement behaviors between Black and White EC and between 2020 and subsequent years. Significance was set at p=0.05 and mean differences are reported. Results: White EC survivors reported significantly more WD-SB (13 hours, p=0.002) and WE-SB (14 hours, p=0.005). White EC survivors reported more MVPA (44 minutes, p=0.012). There were no racial differences in sleep (p=0.534). More WD-SB (10 hours, p=0.015) was reported in 2020 compared to 2021/2022, however there were no differences between years between WE-SB, MVPA, and sleep (all p\u3e 0.05). Conclusions: EC survivors reportedly spend the majority of their day in SB and are not meeting the recommended ACSM MVPA guidelines. Lifestyle interventions aimed at promoting healthy 24-hour activity behaviors should start by targeting one activity behavior at a time and may need to be individualized to start with SB reduction or PA promotion