Public Health Recommendations For Physical Activity Research Articles

Abstract P349: Physical Activity Perceptions and Engagement of Patients Prescribed an Anti-Obesity Medication in a Medical Weight Loss Clinic

Introduction: Physical activity (PA) may elicit important health benefits when coupled with contemporary anti-obesity medications (AOM). However, currently there is little known about perceptions of PA and associated PA engagement of patients receiving these AOM therapies. Hypothesis: We assessed the hypothesis that PA would differ by perceptions of confidence to engage in PA, current and future importance of PA, and PA amount in patients receiving AOM treatment within the context of a medical weight loss clinic. Methods: An electronic survey was distributed to patients in a clinical research registry who were receiving treatment with an AOM at a university medical center-based weight loss clinic. The survey included questions about their perceived confidence to do structured PA or exercise regularly (PA-CONFIDENCE) and perceived importance of structured PA or exercise for management of their body weight currently (PA-IMPORTANCE) or in the future (PA-FUTURE). Participants also reported their current level of PA. Results: Survey responses were received from 96 patients. For these analyses, data were examined for patients currently prescribed a GLP-1 AOM (83 patients). High PA-CONFIDENCE was reported by 44.6% of participants, with 34.9% and 20.5% reporting moderate and low PA-CONFIDENCE, respectively. PA was 154±117 min/wk, 107±105 min/wk, and 76±77 min/wk for high, moderate, and low PA-CONFIDENCE (p=0.033). Participating in ≥150 min/wk of PA was reported by 54.1% with high, 20.7% with moderate, and 11.8% with low PA-CONFIDENCE (p=0.002). Ratings of PA-IMPORTANCE were 63.9% for high, 28.9% for moderate, and 7.2% for low. Participating in ≥150 min/wk of PA was reported by 48.2% with high, 12.5% with moderate, and 0% with low PA-IMPORTANCE (p=0.002). Ratings of PA-FUTURE were 79.5% for high, 18.1% for moderate, and 2.4% for low. Current participation in ≥150 min/wk of PA was reported by 33.7% with high, 12.5% with moderate, and 0% with low PA-FUTURE (p=0.002). Conclusions: Less than one-half of patients prescribed an AOM report confidence to engage in regular structured PA, and of those with high confidence only approximately one-half achieve current public health recommendations for PA. While more than one-half of patients report that PA is important, less than one-half engage in the recommended amount of PA. Strategies are needed to increase perceived confidence to perform and importance of PA in AOM treated patients, and to increase PA participation.

Physical Activity in the Prevention of Childhood Obesity: The Position of the European Childhood Obesity Group and the European Academy of Pediatrics.

Obesity affects an increasing number of children and adolescents. Physical activity (PA) is a significant factor in the prevention of excessive body mass in the pediatric population. A significant percentage of pediatric population do not attain the public health recommendation for PA, and typically, those with higher levels of PA have lower content of body fat than less active peers. Although the development of childhood obesity is multifactorial, the decline in energy expenditure is considered as one of the most important determinants of excessive body weight. The lack of intervention causes that excess body weight to remain stable from birth through childhood and adolescence to adulthood. Accordingly, public health interventions are needed to increase the level of PA in the pediatric population. The task force from the European Childhood Obesity Group and the European Academy of Pediatrics reviewed English language meta-analyses, systematic reviews, randomized clinical trials, and observational studies from PubMed/MEDLINE, Cochrane Library, Science Direct, MEDLINE, and EBSCO databases, from 2018 to August 2020, and developed a consensus statement. This statement presents the role of PA in the prevention of excessive body weight and gives age-appropriate recommendations for PA and recommendations for school-based interventions, parents, and guardians.

Systematic review of the prospective association of daily step counts with risk of mortality, cardiovascular disease, and dysglycemia

BackgroundDaily step counts is an intuitive metric that has demonstrated success in motivating physical activity in adults and may hold potential for future public health physical activity recommendations. This review seeks to clarify the pattern of the associations between daily steps and subsequent all-cause mortality, cardiovascular disease (CVD) morbidity and mortality, and dysglycemia, as well as the number of daily steps needed for health outcomes.MethodsA systematic review was conducted to identify prospective studies assessing daily step count measured by pedometer or accelerometer and their associations with all-cause mortality, CVD morbidity or mortality, and dysglycemia (dysglycemia or diabetes incidence, insulin sensitivity, fasting glucose, HbA1c). The search was performed across the Medline, Embase, CINAHL, and the Cochrane Library databases from inception to August 1, 2019. Eligibility criteria included longitudinal design with health outcomes assessed at baseline and subsequent timepoints; defining steps per day as the exposure; reporting all-cause mortality, CVD morbidity or mortality, and/or dysglycemia outcomes; adults ≥18 years old; and non-patient populations.ResultsSeventeen prospective studies involving over 30,000 adults were identified. Five studies reported on all-cause mortality (follow-up time 4–10 years), four on cardiovascular risk or events (6 months to 6 years), and eight on dysglycemia outcomes (3 months to 5 years). For each 1000 daily step count increase at baseline, risk reductions in all-cause mortality (6–36%) and CVD (5–21%) at follow-up were estimated across a subsample of included studies. There was no evidence of significant interaction by age, sex, health conditions or behaviors (e.g., alcohol use, smoking status, diet) among studies that tested for interactions. Studies examining dysglycemia outcomes report inconsistent findings, partially due to heterogeneity across studies of glycemia-related biomarker outcomes, analytic approaches, and sample characteristics.ConclusionsEvidence from longitudinal data consistently demonstrated that walking an additional 1000 steps per day can help lower the risk of all-cause mortality, and CVD morbidity and mortality in adults, and that health benefits are present below 10,000 steps per day. However, the shape of the dose-response relation is not yet clear. Data are currently lacking to identify a specific minimum threshold of daily step counts needed to obtain overall health benefit.

Resistance Exercise for the Prevention and Treatment of Pediatric Dynapenia

Temporal trends of youth muscular fitness (i.e., muscular strength, muscular power and local muscular endurance) indicate that contemporary children and adolescents are weaker and slower than previous generations. Consequently, this generation of millennials appear to be just as vulnerable as older adults to the inevitable consequences of muscle disuse and neuromuscular dysfunction. The modern-day construct of pediatric dynapenia describes an identifiable and treatable condition in youth characterized by low levels of muscular strength and power and consequent physical and psychosocial limitations not caused by neurologic or muscular disease. An interaction of modifiable physical and psychosocial factors can influence the development and progression of pediatric dynapenia. Without structured interventions that target strength deficits and build strength reserves in a supporting environment, the divergence in performance between weaker and stronger children may persist into adolescence because weaker youth may be unable to break through a so-called strength barrier. Regular participation in a well-designed youth resistance training program provides an opportunity for youth to enhance their health and fitness while acquiring the physical skills and behaviors that support an active lifestyle. New insights have highlighted the importance of initiating strength-building interventions early in life to optimize performance gains in other important components of physical fitness. Developmentally appropriate resistance training should be integrated into school- and community-based youth fitness programs and strength-building activities should take a more prominent position in public health physical activity recommendations for children and adolescents.

Effects of exercise and physical activity promotion: meta-analysis informing the 2018 EULAR recommendations for physical activity in people with rheumatoid arthritis, spondyloarthritis and hip/knee osteoarthritis

ObjectiveTo evaluate the effectiveness of exercise and physical activity (PA) promotion on cardiovascular fitness, muscle strength, flexibility, neuromotor performance (eg, balance) and daily PA in people with rheumatoid arthritis (RA),...

Physical activity and concussion risk in youth ice hockey players: pooled prospective injury surveillance cohorts from Canada

ObjectiveTo examine the association between meeting physical activity (PA) volume recommendations and concussion rates in male ice hockey players aged 11–17 years.DesignPooled prospective injury surveillance cohort data from the 2011–2012,...

2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis

Regular physical activity (PA) is increasingly promoted for people with rheumatic and musculoskeletal diseases as well as the general population. We evaluated if the public health recommendations for PA are...

Fatigue and its relationship with physical activity in adolescents and young adults with traumatic brain injury: a cross-sectional study.

Physical activity (PA) in patients with traumatic brain injury (TBI) may be impaired leading to secondary health issues and limitations in participation. This study aims to determine the level of PA and its determinants in adolescents and young adults with TBI. Cross-sectional survey study. Outpatient clinic of a rehabilitation center. Discharged patients aged 12-39 years with a diagnosis of TBI >6 months treated in the rehabilitation center between 2009-2012. The Activity Questionnaire for Adults and Adolescents (AQuAA) measuring PA, with results dichotomized for meeting or not meeting Dutch recommendations for health-enhancing physical activity (D-HEPA) and the Checklist Individual Strength questionnaire (CIS; range 20-140, higher scores represent higher levels of fatigue), measuring fatigue, were administered. Fifty (47%) of the 107 invited patients completed the questionnaire. Mean age was 25.0±7.2 years and 22 (44%) were male. Eighteen (36%) had a mild injury, 13 (26%) a moderate injury and 19 (38%) a severe injury. Median time spent on moderate-vigorous physical activity was 518 minutes/week (IQR 236-1725) (males performing significantly more minutes on moderate-vigorous activity than women) and on sedentary activity 2728 minutes/week (IQR 1637-3994). Thirty-two (64%) participants met the D-HEPA. According to the CIS, 19 participants (38%) were severely fatigued. Both the CIS total score and the subscales motivation and physical activity were associated with meeting the D-HEPA. The proportion of individuals with TBI meeting D-HEPA was similar to the general population, with the PA level being associated with self-reported fatigue. Physical activity programs are continuously being developed to increase the percentage of individuals meeting public health recommendations for PA; when developing programs for individuals with TBI extra consideration should be taken for the presence of fatigue. As in the general population, females with TBI are less active, PA programs should probably consider gender differences in their development.

Evaluating the quality and accuracy of online physical activity resources for individuals living with osteoporosis

ABSTRACTThe purpose of the present investigation was to examine the quality and accuracy of online physical activity (PA) information for individuals living with osteoporosis. Using a systematic review protocol and guided by previous synthesis research, 57 websites were included in this study. Two independent coders evaluated each website by extracting data pertinent to descriptive characteristics, technical quality, and accuracy of PA information. While most websites presented information regarding aerobic (94.47%) and resistance (89.47%) PA, rarely was information presented consistent with public health recommendations for PA in older adults or recommendations advanced by Giangregorio et al. (2014). Considerably less information was devoted to balance or flexibility forms of activity. Most websites included information on the benefits (94.40%) and safety considerations (72.20%) for PA for individuals living with osteoporosis. Other cognitive or behavioral aspects linked to PA were less common features of coded websites. Greater attention to public health guidelines or evidence-informed recommendations when developing websites to encourage individuals living with osteoporosis to adopt PA is recommended.

Recommended levels of physical activity to avoid adiposity in Spanish children

What is already known about this subject There is an association between adiposity levels and physical activity guidelines for adolescents. Achieving physical activity recommendations helps adolescents to prevent obesity status. What this study adds This paper presents an association between physical activity levels and obesity status. This paper supports physical activity recommendations to avoid children's obesity levels. This paper emphasizes vigorous physical activity for this matter. There is no information about physical activity (PA) recommendations to avoid children's obesity levels and how much of vigorous PA (VPA) is included into the '60 minutes of MVPA 5 days a week' recommendation for children. The aim of this study was to examine the association between PA and adiposity in children and to examine whether the current PA guidelines are associated with a low risk of having excess of body fat in children, with special focus on sex differences, and PA intensity. A sample of 439 Spanish children aged 8-10 years from the European Youth Heart Study participated in the study. The variables measured were anthropometric characteristics (height, weight, body mass index [BMI], skin-folds and waist circumference) and PA was measured during 6 consecutive days using the GT1M accelerometer. Receiver operating characteristic analysis showed significant cut-off points associated with non-overweight: 45 min d(-1) of VPA and 67 min d(-1) of moderate-to-vigorous physical activity (MVPA) (using BMI categories); and non-fat: 41 min d(-1) of VPA and 67 min d(-1) of MVPA (using percentage of body fat) and 38 min d(-1) of VPA and 47 min d(-1) of MVPA (using waist circumference categories) for boys. For girls, the optimal cut-offs of moderate-to-vigorous activity and MVPA associated with non-overweight were 24 and 57 min d(-1) , respectively (BMI). Boys who did not meet 67 min in MVPA had an increased risk of being overweight + obese and overfat + obese (odds ratio [OR] = 2.48, 95% confidence interval [CI] = 1.36, 4.53, and OR = 2.56, 95% CI = 1.12, 5.82). The findings support current PA recommendations (60 min d(-1) of MVPA) to avoid excess of body fat in Spanish children. However, VPA appears to be an important component for the prevention of obesity, and our findings suggest that PA recommendations should specify the dose of VPA required for optimal health. Therefore, public health PA recommendations should incorporate specifically a greater dose of VPA into the total amount of MVPA in 8- to 10-year-old boys.

Social cognitive influences on physical activity participation in long‐term breast cancer survivors

Although physical activity is beneficial for breast cancer survivors, the majority do not meet public health physical activity recommendations. The purpose of this study was to test a social cognitive theory model of physical activity behavior in a sample of long-term breast cancer survivors using both self-report and objective measures of physical activity. Participants (N = 1527) completed measures of physical activity, self-efficacy, goals, outcome expectations, fatigue, and social support at baseline and 6-month follow-up. A subsample (n = 370) was randomly selected to wear an accelerometer. It was hypothesized that self-efficacy directly and indirectly influences physical activity through goals, social support, fatigue, and outcome expectations. Relationships were examined using panel analysis within a covariance modeling framework. The hypothesized model provided a good model-data fit (χ(2) = 1168.73, df = 271, p = <0.001, CFI = 0.96, SRMR = 0.04) in the full sample when controlling for covariates. At baseline, self-efficacy directly and indirectly, via goals, outcome expectations, and social support, influenced physical activity. These relationships were also supported across time. Additionally, the hypothesized model was supported in the subsample with accelerometer data (χ2 = 656.88, df = 330, p < 0.001, CFI = 0.95, SRMR = 0.05). This study validates a social cognitive model for understanding physical activity behavior in long-term breast cancer survivors. Future studies should be designed to replicate this model in other breast cancer survivor populations, and the findings should be applied to the development of future physical activity programs and studies for this population.

Associations between social ecological factors and self-reported short physical activity breaks during work hours among desk-based employees

Objective To examine the associations between potential social ecological correlates and self-reported short physical activity breaks during work hours (defined as any interruption in sitting time during a typical work hour) among a sample of employees who commonly sit for working tasks. Methods 801 employed adults aged 18–70 years from metropolitan Melbourne, Australia were surveyed in 2009 about their short physical activity breaks from sitting during work hours and potential social ecological correlates of this behaviour. Results Men reported significantly more short physical activity breaks per work hour than did women (2.5 vs. 2.3 breaks/h, p = 0.02). A multivariable linear regression analysis adjusting for clustering and meeting the public health physical activity recommendations showed that the factors associated with frequency of short physical activity breaks per work hour were perceptions of lack of time for short physical activity breaks for men (− 0.31 breaks/h, 95% confidence intervals [CI] − 0.52, − 0.09) and lack of information about taking short physical activity breaks for women (− 0.20 breaks/h, CI − 0.47, − 0.05). Conclusion These findings suggest that providing male employees with support for short physical activity breaks during work hours, and female employees with information on benefits of this behaviour may be useful for reducing workplace sedentary time.

Physical activity is associated with clinically important differences in health-related quality of life among rural and small-town breast cancer survivors

The primary purpose of this study was to examine differences in health-related quality of life and fatigue between rural and small-town (RST) breast cancer survivors meeting and not meeting public health physical activity (PA) recommendations. Using a retrospective survey design, RST breast cancer survivors (N = 524) residing in Southern Alberta, Canada completed a mailed questionnaire assessing self-reported prediagnosis, on treatment, and current PA behavior, and current health-related quality of life and fatigue. Analyses indicated 44.1%, 13.7%, and 34.7% of RST breast cancer survivors met public health PA recommendations during prediagnosis, on treatment, and post-treatment (i.e., current) time periods, respectively. Multivariate analyses of variance suggested indicated survivors currently meeting PA recommendations reported clinically advantageous differences in health-related quality of life and fatigue symptoms than survivors not currently meeting PA recommendations. Repeated measures analyses also indicated significant differences in PA behavior across the three cancer-related time periods (all p < 0.01). The results of this study provide evidence that RST breast cancer survivors have similar PA behavior estimates across the cancer trajectory to urban survivors. Being physically active was associated with clinically important advantages with respect to health-related quality of life and fatigue. Strategies designed to facilitate PA behavior in the RST breast cancer survivor population are warranted.

IH-108: Objective quantification of amount and intensity of Physical Activity (PA) in bariatric surgery candidates and age- and sex-matched Normal Weight (NW) controls

Physical Activity (PA) is an important component of weight loss programs and may be encouraged for patients undergoing bariatric surgery. However, it is unclear how PA patterns may differ between bariatric surgery candidates and Normal Weight (NW) individuals when PA is assessed objectively. This study used objective PA measures to: 1) assess levels of PA at different intensities in bariatric surgery candidates and 2) compare these PA levels with those of NW individuals within the context of public health PA recommendations.

Using three objective criteria to examine pedometer guidelines for free-living individuals

The purpose was to examine in free-living individuals from a high-density city (1) the objectively determined physical activity levels across quartiles derived from pedometer step counts, (2) the pedometer steps day(-1) required to meet health-enhancing guidelines of accruing 30 min day(-1) of moderate physical activity and (3) the agreement between three objective criteria for the pedometer guidelines. Over 7 days 49 Hong Kong Chinese aged 15-55 years (n = 30 males) wore a polar heart rate monitor (HRM), an MTI and Tritrac accelerometer, plus a Yamax pedometer for >or=600 min day(-1). Participants averaged 9,839 +/- 3,088 steps day(-1), whilst accumulating 44.5 +/- 22.6, 43.1 +/- 21.7, and 24.7 +/- 19.3 min day(-1) of moderate physical activity by the Tritrac, MTI and HRM, respectively. Significant differences between quartiles of pedometer-determined activity were predominantly seen in the accelerometry data, especially during moderate and moderate-to-vigorous intensity activity (effect sizes >1.5 between upper and lower quartiles), but not seen in the HRM data. Using both criterion accelerometer datasets, a threshold of 8,000 steps day(-1) accurately categorized approximately 90% of those achieving, and approximately 80% of those not achieving, 30 min day(-1) of appropriate activity. They also produced a screening sensitivity of approximately 95% and a specificity of approximately 70%, which were considerably higher than those from the HRM data. Overall, the agreement between the three criterion measures suggests 8,000 steps day(-1) might be a valid screening tool as a proxy for classifying those meeting public health physical activity recommendations of 30 min day(-1) of moderate activity.

Suitability and readability assessment of educational print resources related to physical activity: Implications and recommendations for practice

Objective The primary objective of this study was to assess the suitability and readability level of publicly available educational print resources related to physical activity (PA). Methods Educational print resources related to PA ( n = 66) were requested from organizations (e.g., professional, commercial, government, and educational). The suitability assessment of materials (SAM) and the simple measure of gobbledygook (SMOG) readability measure were used to evaluate the suitability and readability of the PA resources. Results Of the 66 PA resources, suitability scores were superior in only 10 resources (15%), adequate in 36 resources (55%), and inadequate/not suitable in 20 resources (30%). The average reading grade level for the PA resources was a 10th grade level (S.D. = 1.82; Rg = 5th grade to 15th grade). Only 56.5% ( n = 35) of PA resources depicted a primary PA recommendation that was consistent with the public health recommendation for PA. Conclusion Results indicate that the majority of educational print resources related to PA have poor readability indices and inadequate to adequate suitability. Practice implications Health educators developing educational print resources related to PA must ensure these resources conform to the highest suitability standards. This includes developing resources that a) contain information consistent with current public health recommendations, and b) can be utilized by all individuals regardless of health literacy status.

Preliminary Evidence To Suggest Accumulating 8,000 Steps/ Day May Meet Physical Activity Promotion Guidelines

It is well recognized that a sedentary lifestyle is detrimental to health, whilst habitually participating in moderate and vigorous physical activities can confer important health benefits. Yet there is a paucity of empirical studies objectively determining whether pedometry can be used to accurately quantify the levels of habitual physical activity needed to meet accepted public health recommendations. PURPOSE: To examine in free-living individuals residing in a high-density Asian city (i) objectively determined levels of physical activity across quartiles derived from pedometer step counts, and (ii) the pedometer steps/day required to meet health enhancing guidelines of accruing 30 min/day of moderate physical activity. METHODS: Over seven consecutive days a convenience sample of 49 Hong Kong Chinese aged 15-55 yr (n = 30 males) wore a heart rate monitor (HRM), a uniaxial as well as a triaxial accelerometer, plus a pedometer for ≥600 min during waking hours. RESULTS: Participants averaged 9839 ± 3088 steps/day, 841 ± 71 triaxial accelerometer counts/min, 837 ± 70 uniaxial accelerometer counts/min, and a HRM "activity heart rate" of 26 ± 5 beats/min. Significant differences between quartiles of pedometer-determined activity were predominantly seen from the accelerometry data, especially during moderate intensity and during moderate-to-vigorous intensity activity (effect sizes >1.5 between upper and lower quartiles). Using the criterion accelerometer data, a threshold of 8000 steps/day accurately categorized ∼90% of those achieving, and ∼80% of those not achieving, 30 min/day of appropriate activity; and produced a screening sensitivity of ∼95% and a specificity of ∼70%. CONCLUSION: Quartiles of average daily pedometer step-counts can be used to accurately stratify levels of habitual physical activity achieved by residents of a high density Asian city. Moreover, a threshold of 8000 steps/day appears to have the potential of being a valid screening tool possessing the specificity and sensitivity necessary to be used as a proxy for classifying those individuals meeting public health physical activity recommendations of 30 min/day of moderate activity. Further studies are required to test these preliminary findings using a larger and more diverse sample of the population.

Analyzing Theoretical Mechanisms of Physical Activity Behavior Change in Breast Cancer Survivors: Results from the Activity Promotion (ACTION) Trial

We previously reported that a physical activity (PA) behavior change intervention based on the theory of planned behavior (TPB) increased PA and quality of life in breast cancer survivors. To examine the effects of our interventions on TPB variables and to determine if PA at 12 weeks follow-up was mediated by TPB variables at 4 weeks. Breast cancer survivors (N = 377) were randomly assigned to receive either a standard public health recommendation for PA (SR group), a step pedometer alone, or one of two TPB-based behavior change interventions consisting of print materials (alone or combined with a step pedometer). For the purpose of this study, we compared the two TPB-based intervention groups (INT group) to the SR group. Compared to the SR group, the INT group reported more favorable changes in instrumental attitude (mean difference = 0.13; 95% CI = -0.01 to 0.23; d = 0.19; p = 0.077), intention (mean difference = 0.33; 95% CI = 0.10 to 0.56; d = 0.33; p = 0.006), and planning (mean difference = 0.39; 95% CI = 0.04 to 0.73; d = 0.26; p = 0.027). Mediation analyses indicated that both planning and intention partially mediated the effects of the intervention on PA at 12 weeks. Our TPB-based behavior change intervention resulted in small improvements in the TPB constructs that partially mediated the effects of our intervention on PA behavior. Additional research with the TPB is warranted.

Maintenance of Physical Activity in Breast Cancer Survivors after a Randomized Trial

The purpose of this study was to examine the longer-term effects of pedometers and print materials on changes in physical activity (PA) and health-related quality of life (HRQoL) in breast cancer survivors who participated in a 3-month behavior change intervention. Breast cancer survivors (N = 377) were randomly assigned to receive either (a) a standard public health recommendation for PA (SR), (b) previously developed breast cancer-specific PA print materials (PM), (c) a step pedometer (PED), or (d) a combination of the two (COM). The primary endpoint was self-reported moderate/vigorous PA minutes per week at 6-month follow-up after the initial 3-month intervention period. Seventy-one percent (266/377) of participants completed the 6-month follow-up assessment. According to intention-to-treat linear mixed-model analyses, self-reported moderate to vigorous PA increased by 9 min x wk(-1) in the SR group compared with 39 min x wk(-1) in the PM group (mean difference = 30 min x wk(-1); 95% CI = -44 to 104; P = 0.425), 69 min x wk(-1) in the PED group (mean difference = 60 min x wk(-1); 95% CI = -13 to 132; P = 0.107), and 56 min x wk(-1) in the COM group (mean difference = 47 min x wk(-1); 95% CI = -26 to 119; P = 0.210). The same pattern was observed for self-reported, brisk walking. No differences were found for HRQoL or fatigue. Breast cancer-specific PM and PED did not maintain significantly higher PA or HRQoL at 6-month follow-up in breast cancer survivors, but the magnitude of the effect on PA (30-60 min x wk(-1)) was consistent with the immediate postintervention effect observed at the 3-month postintervention time point. Issues of power resulting from additional loss to follow-up may account for the failure to achieve statistical significance. Additional research with larger sample sizes and more complete follow-up is warranted.

Randomized Controlled Trial of the Effects of Print Materials and Step Pedometers on Physical Activity and Quality of Life in Breast Cancer Survivors

To determine the effects of breast cancer-specific print materials and step pedometers on physical activity (PA) and quality of life (QoL) in breast cancer survivors. Breast cancer survivors (N = 377) were randomly assigned to receive one of the following: a standard public health recommendation for PA, previously developed breast cancer-specific PA print materials, a step pedometer, or a combination of breast cancer-specific print materials and step pedometers. The primary outcome was self-reported moderate/vigorous PA minutes per week. Secondary outcomes were QoL (Functional Assessment of Cancer Therapy-Breast), fatigue, self-reported brisk walking, and objective step counts. Assessments were conducted at baseline and postintervention (12 weeks). Attrition was 10.3% (39 of 377). On the basis of linear mixed-model analyses, PA increased by 30 minutes/week in the standard recommendation group compared with 70 minutes/week in the print material group (mean difference, 39 minutes/week; 95% CI = -10 to 89; d = 0.25; P = .117), 89 minutes/week in the pedometer group (mean difference, 59 minutes/week; 95% CI, 11 to 108; d = 0.38; P = .017), and 87 minutes/week in the combined group (mean difference, 57 minutes/week; 95% CI, 8 to 106; d = 0.37; P = .022). For brisk walking minutes/week, all three intervention groups reported significantly greater increases than the standard recommendation group. The combined group also reported significantly improved QoL (mean difference, 5.8; 95% CI, 2.0 to 9.6; d = 0.33; P = .003) and reduced fatigue (mean difference, 2.3; 95% CI, 0.0 to 4.7; d = 0.25; P = .052) compared with the standard recommendation group. Breast cancer-specific PA print materials and pedometers may be effective strategies for increasing PA and QoL in breast cancer survivors. A combined approach appears to be optimal. ClinicalTrials.gov Identifier NCT00221221