Bernardine M. Pinto

Objective: Theory‐based physical activity (PA) interventions improve moderate to vigorous physical activity (MVPA) among breast cancer survivors, yet limited research has examined when psychosocial changes occur during intervention delivery. Understanding temporal changes in theoretical constructs during PA adoption may enhance intervention delivery and outcomes. The purpose of this study is to examine longitudinal changes in self‐efficacy, self‐regulation and affect (intrapersonal constructs from Social Cognitive Theory) and social support (interpersonal construct) during a 12‐week theory‐based PA program (webMFT) and their association with participants' active minutes (measured by Fitbit) over 12 weeks and intervention engagement (receipt of 12 weekly peer coaching calls). Methods: In a randomized controlled trial with 61 participants, 30 were randomized to receive webMFT (mean age = 58.1 [SD = 8.55], 1.40 years post‐diagnosis [SD = 0.5], 80% Stage 0–1 cancer, 80% White) delivered by 10 peer coaches. Only the webMFT participants were assessed; the comparison group (MVPA Tracking) was not included in the analyses. webMFT participants received a Fitbit tracker and weekly PA coaching calls tailored to Fitbit PA data. At baseline, 4, 8 and 12 weeks, they completed questionnaires assessing multidimensional self‐efficacy (task, coping, scheduling), self‐regulation skills, affective response and social support for PA. Mixed effects regression models examined changes in constructs and their association with Fitbit active minutes/week and intervention engagement. Results: Increases in total self‐efficacy, scheduling self‐efficacy, positive affect and social support from family and friends were significantly associated with participants' PA over 12 weeks. There were no significant associations between changes in self‐regulation skills, task or coping self‐efficacy with PA. Improvements in total self‐efficacy, scheduling self‐efficacy, self‐regulation, affective response and family social support were positively associated with intervention engagement. Conclusions: Participants' self‐efficacy, specifically, for scheduling PA, positive affect and social support for PA adoption and intervention engagement merit future examination.

Background: Breast cancer survivors are increasing in number and living longer but often experience reduced quality of life (QOL) from treatment sequelae. Physical activity (PA) interventions can improve QOL, but many rely on costly specialists or are difficult to scale. We adapted an evidence-based peer-mentoring program (moving forward together) for web delivery (webMFT). The platform centralizes peer-coach matching, delivery, and coordination to reduce administrative burden and improve scalability. Purpose: We evaluated webMFT’s cost-effectiveness. Methods: In a 12-week randomized trial (N = 61), survivors were assigned to webMFT (n = 30; weekly phone calls plus activity self-monitoring) or MVPA Tracking (n = 31; activity self-monitoring only). From a payer’s perspective, we estimated incremental cost-effectiveness ratios (ICERs) for quality-adjusted life years (QALYs) and device-measured moderate-to-vigorous physical activity (MVPA). Intervention costs were collected from time logs for research staff and peer coaches. We conducted sensitivity analyses by bootstrapping and constructing cost-effectiveness planes and cost-effectiveness acceptability curves (CEACs). Results: In the base-case analysis the ICER for webMFT was $38 430 per QALY gained versus MVPA Tracking. At the high end of probabilistic implementation-cost sensitivity analyses that considered wider ranges of wages, platform costs, and implementation times, the mean ICER was $43 418 per QALY and the probability of cost-effectiveness was 87% at the commonly used $150 000 per QALY threshold. WebMFT increased QALYs but did not produce greater increases in device-measured PA compared with MVPA Tracking. Conclusion: At a $150 000 per QALY threshold, webMFT appears cost-effective for improving QALYs among breast cancer survivors. Larger studies are needed to confirm these findings. Clinical Trial Information: This underlying clinical trial was registered at clinicaltrials.gov (NCT05409664).

Purpose: We previously demonstrated that a 3-month peer-delivered program (Moving Forward Together, MFT) significantly increased breast cancer survivors’ moderate-to-vigorous PA (MVPA). To enhance MFT’s scalability and reach, we adapted it to an existing web platform and developed webMFT. Our goal was to test the efficacy of webMFT on survivors’ MVPA. Methods: In a randomized controlled trial, we trained ten peer coaches from cancer care organizations to deliver webMFT or MVPA Tracking to 61 breast cancer survivors (mean age = 58.10 years [SD = 8.55], 1.40 years post-diagnosis [SD = 0.50], 80% Stage 0–1 cancer) for 3 months. Both groups received a FitBit® tracker and behavioral supports of weekly synchronization reminders, physical activity (PA) tipsheets, and recommended PA goals. In addition, webMFT participants received weekly coaching calls tailored to their FitBit® data shared through the web platform. All participants wore an Actigraph accelerometer for 7 days at baseline and at post-intervention and completed quality of life (QOL), mood, fatigue and physical functioning questionnaires. We used mixed effects regression models to examine between-group differences on outcomes. Results: Both groups significantly increased their MVPA from baseline to 12 weeks but there were no significant between-group differences in change in MVPA (b = − 22.84, SE = 16.99, p = .18). There were significant between-group effects favoring webMFT in improved QOL at 12 weeks (b = 1.56, SE = 0.77, p = .04). Conclusions: Adapting the efficacious MFT intervention for web delivery did not result in significant improvements in MVPA vs. MVPA Tracking. This raises questions as to whether the efforts undertaken to adapt and deliver the program through the web platform were justified as compared to MVPA Tracking with behavioral supports. Implications for Cancer Survivors: Promoting PA does not require web delivery of coaching—using physical activity trackers with weekly reminders and resources is also effective. Trial registration: This trial was registered in Clinicaltrials.gov on 6/8/2022 (NCT05409664).

Background: Interventions promoting physical activity (PA) among survivors of cancer improve their functioning, reduce fatigue, and offer other benefits in cancer recovery and risk reduction for future cancer. There is a need for interventions that can be implemented on a wider scale than that is possible in research settings. We have previously demonstrated that a 3-month peer-delivered PA program (Moving Forward Together [MFT]) significantly increased the moderate to vigorous PA (MVPA) of survivors of breast cancer. Objective: Our goal is to scale up the MFT program by adapting an existing peer mentoring web platform, Mentor1to1. InquistHealth’s web platform (Mentor1to1) has demonstrated efficacy in peer mentoring for chronic disease management. We will partner with InquisitHealth to adapt their web platform for MFT. The adaptation will allow for automating key resource-intensive components such as matching survivors with a coach via the web-based peer mentoring platform and collecting key indexes to prepare for large-scale implementation. The aim is to streamline intervention delivery, assure fidelity, and improve survivor outcomes. Methods: In phase 1 of this 2-phase study, we will interview 4 peer mentors or coaches with experience in delivering MFT and use their feedback to create Mentor1to1 web platform adapted for MFT (webMFT). Next, another 4 coaches will participate in rapid, iterative user-centered testing of webMFT. In phase 2, we will conduct a randomized controlled trial by recruiting and training 10 to 12 coaches from cancer organizations to deliver webMFT to 56 survivors of breast cancer, who will be assigned to receive either webMFT or MVPA tracking (control) for 3 months. We will assess effectiveness with survivors’ accelerometer-measured MVPA and self-reported psychosocial well-being at baseline and 3 months. We will assess implementation outcomes, including acceptability, feasibility, and program costs from the perspective of survivors, coaches, and collaborating organizations, as guided by the expanded Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. Results: As of September 2023, phase 1 of the study was completed, and 61 survivors were enrolled in phase 2. Using newer technologies for enhanced intervention delivery, program management, and automated data collection has the exciting promise of facilitating effective implementation by organizations with limited resources. Adapting evidence-based MFT to a customized web platform and collecting data at multiple levels (coaches, survivors, and organizations) along with costs will provide a strong foundation for a robust multisite implementation trial to increase MVPA and its benefits among many more survivors of breast cancer. Conclusions: The quantitative and qualitative data collected from survivors of cancer, coaches, and organizations will be analyzed to inform a future larger-scale trial of peer mentoring for PA delivered by cancer care organizations to survivors. Trial Registration: ClinicalTrials.gov NCT05409664; https://clinicaltrials.gov/study/NCT05409664 International Registered Report Identifier (IRRID): DERR1-10.2196/52494

Objective: To examine the effects of three programs aimed at maintaining moderate‐to‐vigorous physical activity (MVPA) on breast cancer survivors' quality of life, physical functioning, fatigue and mood.Methods: 161 survivors participated in a 12‐month randomized controlled study and were assigned to one of three groups: Reach Plus, Reach Plus Message, or Reach Plus Phone. All participants received the same intervention for the first 3 months (weekly calls from peer coach) for MVPA adoption. In Months 4–9, Reach Plus monitored MVPA and received feedback reports. Reach Plus Message monitored MVPA and received weekly text/email messages and feedback reports. Reach Plus Phone participants monitored MVPA and received monthly calls from coaches and feedback reports. Intervention delivery ended at 9 months. Assessments were obtained at baseline, 3, 6, 9, and 12‐months. Analyses used a series of longitudinal mixed effects models with subject‐specific intercepts.Results: All groups improved significantly across time on psychosocial measures. At 9 months, Reach Plus Message and Reach Plus Phone reported better physical functioning compared to Reach Plus (b = 8.27, 95% CI: [2.27, 14.27]; b = 4.89, 95% CI: [0.01, 10.53]) respectively). At 12 months, Reach Plus Message reported better physical functioning than Reach Plus (b = 4.52, 95% CI: [0.01, 9.75]. Participants who met national PA guidelines reported significantly lower fatigue and higher physical functioning (at 9 and 12 months), and improved mood (at 12 months).Conclusions: MVPA maintenance via weekly messages or monthly coach calls improved physical functioning. Maintaining MVPA at or above national recommendations was associated with improved physical functioning, mood and less fatigue.

Purpose Despite recommendations for cancer survivors to participate in routine physical activity (PA), offering programs that fit both survivors’ needs and sponsoring organizations’ resources remains a challenge. The purpose of this study is to explore the perspectives of cancer survivors and organizational stakeholders with the intent of developing PA peer-led programs that organizations can implement into their programming. Methods This study explored cancer survivors’ (n = 11) and cancer care organizational stakeholders’ (n = 27) perspectives on the design and feasibility of PA programs targeted for cancer survivors. Semi-structured interview guides were developed for survivors and stakeholders; interviews lasted approximately 30 min. Two analysts used a thematic analysis approach and independently conducted a line-by-line coding of each transcript. With guidance from a senior analyst, the codes were collapsed into themes and subthemes. Results The qualitative analysis of the interview data resulted in seven major themes relating to PA program development and success. Survivor-related themes included the following: (1) developing PA programs based on cancer survivors’ characteristics and experiences; (2) perceived value and importance of accessible, face-to-face instruction; (3) ensuring success based on physical abilities and limitations of the survivor; and (4) the value of physician recommendation for PA participation. Organization-related themes included the following: (1) incorporating participant and community input into program offerings; (2) program feasibility and sustainability; (3) incorporating organizational experience when adopting new program initiatives. Conclusion These findings highlight the challenges of developing viable PA programs for cancer survivors and may guide organizations in future program development and implementation.

BACKGROUND Interventions promoting physical activity (PA) among survivors of cancer improve their functioning, reduce fatigue, and offer other benefits in cancer recovery and risk reduction for future cancer. There is a need for interventions that can be implemented on a wider scale than that is possible in research settings. We have previously demonstrated that a 3-month peer-delivered PA program (Moving Forward Together [MFT]) significantly increased the moderate to vigorous PA (MVPA) of survivors of breast cancer. OBJECTIVE Our goal is to scale up the MFT program by adapting an existing peer mentoring web platform, Mentor1to1. InquistHealth’s web platform (Mentor1to1) has demonstrated efficacy in peer mentoring for chronic disease management. We will partner with InquisitHealth to adapt their web platform for MFT. The adaptation will allow for automating key resource-intensive components such as matching survivors with a coach via the web-based peer mentoring platform and collecting key indexes to prepare for large-scale implementation. The aim is to streamline intervention delivery, assure fidelity, and improve survivor outcomes. METHODS In phase 1 of this 2-phase study, we will interview 4 peer mentors or coaches with experience in delivering MFT and use their feedback to create Mentor1to1 web platform adapted for MFT (webMFT). Next, another 4 coaches will participate in rapid, iterative user-centered testing of webMFT. In phase 2, we will conduct a randomized controlled trial by recruiting and training 10 to 12 coaches from cancer organizations to deliver webMFT to 56 survivors of breast cancer, who will be assigned to receive either webMFT or MVPA tracking (control) for 3 months. We will assess effectiveness with survivors’ accelerometer-measured MVPA and self-reported psychosocial well-being at baseline and 3 months. We will assess implementation outcomes, including acceptability, feasibility, and program costs from the perspective of survivors, coaches, and collaborating organizations, as guided by the expanded Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. RESULTS As of September 2023, phase 1 of the study was completed, and 61 survivors were enrolled in phase 2. Using newer technologies for enhanced intervention delivery, program management, and automated data collection has the exciting promise of facilitating effective implementation by organizations with limited resources. Adapting evidence-based MFT to a customized web platform and collecting data at multiple levels (coaches, survivors, and organizations) along with costs will provide a strong foundation for a robust multisite implementation trial to increase MVPA and its benefits among many more survivors of breast cancer. CONCLUSIONS The quantitative and qualitative data collected from survivors of cancer, coaches, and organizations will be analyzed to inform a future larger-scale trial of peer mentoring for PA delivered by cancer care organizations to survivors. CLINICALTRIAL ClinicalTrials.gov NCT05409664; https://clinicaltrials.gov/study/NCT05409664 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/52494

Background: Most physical activity (PA) interventions in young adult cancer survivors (YACS) have focused on short‐term outcomes without evaluating longer‐term outcomes and PA maintenance. This study examined the effects of an mHealth PA intervention at 12 months, after 6 months of tapered contacts, relative to a self‐help group among 280 YACS.Methods: YACS participated in a 12‐month randomized trial that compared self‐help and intervention groups. All participants received an activity tracker, smart scale, individual videochat session, and access to a condition‐specific Facebook group. Intervention participants also received lessons, tailored feedback, adaptive goal setting, text messages, and Facebook prompts for 6 months, followed by tapered contacts. Accelerometer‐measured and self‐reported PA (total [primary outcome], moderate‐to‐vigorous [MVPA], light, steps, sedentary behaviors) were collected at baseline, 6, and 12 months. Generalized estimating equation analyses evaluated group effects on outcomes from baseline to 12 months.Results: From baseline to 12 months, there were no between‐ or within‐group differences in accelerometer‐measured total PA min/week, while increases in self‐reported total PA were greater in the intervention versus self‐help group (mean difference = +55.8 min/week [95% CI, 6.0–105.6], p = 0.028). Over 12 months, both groups increased accelerometer‐measured MVPA (intervention: +22.5 min/week [95% CI, 8.8–36.2] vs. self‐help: +13.9 min/week [95% CI, 3.0–24.9]; p = 0.34), with no between‐group differences. Both groups maintained accelerometer‐measured and self‐reported PA (total, MVPA) from 6 to 12 months. At 12 months, more intervention participants reported meeting national PA guidelines than self‐help participants (47.9% vs. 33.1%, RR = 1.45, p = 0.02).Conclusion: The intervention was not more effective than the self‐help group at increasing accelerometer‐measured total PA over 12 months. Both groups maintained PA from 6 to 12 months. Digital approaches have potential for promoting sustained PA participation in YACS, but additional research is needed to identify what strategies work for whom, and under what conditions.

The evidence for the survival and health benefits of physical activity (PA) among cancer survivors is well documented. However, it has been challenging to maintain PA among cancer survivors. To evaluate the cost-effectiveness of peer support to encourage maintenance of moderate-to-vigorous physical activity (MVPA) among breast cancer survivors. Participants were randomized into Reach Plus Message (weekly text/email messages), Reach Plus Phone (monthly phone calls) or Reach Plus (a self-monitoring intervention) over 6 months after an initial adoption phase. We calculated the incremental cost-effectiveness ratios (ICER) in terms of quality-adjusted years life years (QALYs) and self-reported MVPA, from the payer’s budgetary and societal perspectives over 1 year. Intervention costs were collected via time logs from the trainers and peer coaches, and participant costs from the participants via surveys. For our sensitivity analyses, we bootstrapped costs and effects to construct cost-effectiveness planes and acceptability curves. The intervention that provides weekly messages from peer coaches has an ICER of $14,446 per QALY gained and $0.95 per extra minute of MVPA per day over Reach Plus. Reach Plus Message has a 49.8% and 78.5% probability of cost-effectiveness respectively when decision makers are willing to pay approximately $25,000 per QALY and $10 per additional minute of MVPA. Reach Plus Phone, which requires tailored monthly telephone calls, costs more than Reach Plus Message but yields less QALY and self-reported MVPA at 1 year. Reach Plus Message may be a viable and cost-effective intervention strategy to maintain MVPA among breast cancer survivors.