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Introduction: Physical activity interventions can improve sleep quality in breast cancer survivors. This paper examines the effects of the ACTIVATE Trial, a wearable-based physical activity intervention (Garmin Vivofit2® coupled with behavioral feedback, goal setting, and health coaching) on sleep outcomes. Methods: Post-primary treatment, inactive, postmenopausal breast cancer survivors were recruited and randomized to primary intervention or waitlist. Wrist-worn actigraphy (sleep onset latency, SOL; total sleep time, TST; sleep efficiency, SE; wake after sleep onset, WASO; and number of awakenings, NWAKE) and questionnaire-derived sleep measures (Pittsburgh Sleep Quality Index) were assessed at baseline (T1), 12 weeks (end of primary intervention and start of waitlist intervention, T2), and at 24 weeks (T3). Results: Eighty-three women (mean age = 62 years) were randomized; trial retention was 94% at T2 and 87% at T3. At T2, primary intervention participants had greater improvements in WASO (− 5.7 min, 95% CI − 11.7 to − 0.2) and NWAKE compared with the waitlist arm (− 2.0, 95% CI − 3.6 to − 0.4). At T3, within-group improvements were observed for SE (both groups), WASO (both groups), NWAKE (primary intervention group only), total PSQI score (primary intervention group), and sleep efficacy (primary intervention group). Conclusions: The intervention reduced actigraphy-measured sleep disturbances. Within-group analyses suggest that improvements in sleep quality are sustained over a longer duration, and there may be similar benefits from an abridged intervention (wearable device only). Actigraphy-measured effects appeared stronger in participants who were poor sleepers at study entry. Implications for Cancer Survivors: Wearable technology can increase physical activity and improve sleep for breast cancer survivors Refereed/Peer-reviewed

Purpose Circadian rhythms control a wide range of physiological processes and may be associated with fatigue, depression, and sleep problems. We aimed to identify subgroups of breast cancer survivors based on symptoms of fatigue, insomnia, and depression; and assess whether circadian parameters (i.e., chronotype, amplitude, and stability) were associated with these subgroups over time. Methods Among breast cancer survivors, usual circadian parameters were assessed at 3–4 months after diagnosis (T0), and symptoms of fatigue, depression, and insomnia were assessed after 2–3 years (T1, N = 265) and 6–8 years (T2, N = 169). We applied latent class analysis to classify survivors in unobserved groups (“classes”) based on symptoms at T1. The impact of each of the circadian parameters on class allocation was assessed using multinomial logistic regression analysis, and changes in class allocation from T1 to T2 using latent transition models. Results We identified 3 latent classes of symptom burden: low (38%), moderate (41%), and high (21%). Survivors with a late chronotype (“evening types”) or low circadian amplitude (“languid types”) were more likely to have moderate or high symptom burden compared to “morning types” and “vigorous types,” respectively. The majority of survivors with moderate (59%) or high (64%) symptom burden at T1 had persistent symptom burden at T2. Implications for Cancer Survivors A late chronotype and lower circadian amplitude after breast cancer diagnosis were associated with greater symptoms of fatigue, depression, and insomnia at follow-up. These circadian parameters may potentially be novel targets in interventions aimed at alleviating symptom burden among breast cancer survivors.

Purpose: To investigate the longitudinal associations between demographic, clinical and lifestyle factors, and changes in patient-reported outcomes (PROs) in cancer survivors 6–9 years post-diagnosis in Western Australia. Methods: A total of 290 individuals participated in this study. Three-quarters of participants were female, and 55%, 31%, and 14% were survivors of breast cancer, colon cancer, and non-Hodgkin lymphoma (NHL), respectively. PROs (fatigue, depression, and health-related quality of life (HRQOL)) were reported at two time points (2012–13 and 2017). Descriptive statistics were used to assess the overall changes over time and linear mixed models were used to identify factors associated with changes over time, after adjusting for confounders. Results: No significant changes were observed in PROs between time point 1 and follow-up at the population level, yet a notable proportion of participants (23% for fatigue, 10% for depression, and 39% for HRQOL) reported a negative minimal clinically important difference (MCID). Being non-Caucasian and having had NHL were associated with negative changes over time. Being obese and having had radiotherapy were related to improved outcomes. Conclusion: Cancer survivors whose levels of fatigue, depression, and quality of life are compromised during cancer treatment may require intervention even 6–9 years post-treatment. Our results suggest particular attention should be paid to those who are non-Caucasian and who have had NHL. This is crucial for providing appropriate care and to support those who are at increased risk of deteriorating naturally over time. Refereed/Peer-reviewed

Statement of problem Lung cancer survivors report among the highest levels of depression and anxiety compared to other tumor groups. To date, no studies have examined associations of accelerometer-assessed activity and sedentary time with psychosocial health outcomes among lung cancer survivors. The objective of this study was to determine associations of accelerometer-assessed light intensity physical activity, moderate-to-vigorous intensity physical activity (MVPA), and sedentary time with psychosocial health among lung cancer survivors. Method Lung cancer survivors in Southern Alberta completed a mailed survey that assessed measures of depressive symptoms (PHQ-9; Patient Health Questionnaire-9: range = 0-27), anxiety (State Anxiety Inventory: range = 10-40), satisfaction with life (SWL; Satisfaction With Life Scale: range = 5-35), and posttraumatic growth (PTG; Posttraumatic Growth Inventory: range = 0-105). Participants also wore an Actigraph ® GT3X + accelerometer for seven days. Quantile regression was used to examine associations of depression, anxiety, SWL, and PTG with light intensity physical activity, MVPA, and sedentary time. Results A total of 127 lung cancer survivors participated for a 24% response rate. Total sedentary time min/day was associated with depressive symptoms at the 50 th percentile (β = 0.02, 95% CI: 0.0–0.03), SWL at the 25 th percentile (β = -0.04, 95% CI: -0.07-0.0) and 50 th percentile (β = -0.03, 95% CI: -0.05 to -0.01). Total light-intensity physical activity mins/day was associated with SWL at the 25 th (β = 0.04, 95% CI: 0.00–0.07) and 50 th (β = 0.03, 95% CI: 0.0–0.05) percentiles, and depressive symptoms at the 50 th percentile (β = -0.02, 95% CI: -0.03-0.00). Total MVPA min/day was not associated with any psychosocial health outcomes. Conclusions Sedentary time and light intensity physical activity were significantly associated with some psychosocial health outcomes. Reducing sedentary time and increasing light intensity physical activity may be a more appropriate recommendation for many lung cancer survivors given their older age, poorer functional status, and reduced pulmonary capacity.

Background: Physical activity is positively associated with survival and quality of life among breast cancer survivors. Despite these benefits, the majority of breast cancer survivors are insufficiently active. The potential health benefits of reducing sedentary behaviour (sitting time) in this population have not been extensively investigated. The ACTIVATE Trial will evaluate the efficacy of an intervention that combines wearable technology (the Garmin Vivofit2®) with traditional behavioural change approaches to increase physical activity and reduce sedentary behaviour performed by breast cancer survivors. Methods/design: This randomised controlled trial includes inactive, postmenopausal women diagnosed with stage I-III breast cancer who have completed their primary treatment. Participants are randomly assigned to the primary intervention group (Garmin Vivofit2®; behavioural feedback and goal setting session; and, five telephone-delivered health coaching sessions) or to the wait-list control group. The primary intervention is delivered over a 12-week period. The second 12-week period comprises a maintenance phase for the primary intervention group, and an abridged intervention (Garmin Vivofit2® only) for the wait-list control group. Moderate- to vigorous-intensity physical activity (MVPA) and sedentary behaviour are assessed by accelerometry at baseline (T1), end of intervention (T2), and end of maintenance phase (T3). Discussion: The ACTIVATE Trial is one of the first studies to incorporate wearable technology into an intervention for cancer survivors. If the use of wearable technology (in combination with behaviour change strategies, or alone) proves efficacious, it may become an inexpensive and sustainable addition to the health promotion strategies available to health care providers in the cancer survivorship context. Trial registration: ACTRN12616000175471. Refereed/Peer-reviewed

Background: High levels of sedentary behavior may negatively affect health outcomes in cancer survivors. A systematic review and meta‐analysis was performed to clarify whether postdiagnosis sedentary behavior is related to survival, patient‐reported outcomes, and anthropometric outcomes in cancer survivors. Methods: The Ovid MEDLINE, EMBASE, CINAHL (The Cumulative Index to Nursing and Allied Health Literature), and SPORTDiscus databases were searched from study inception to June 2019. Studies of adults who had been diagnosed with cancer that examined the association between sedentary behavior and mortality, patient‐reported outcomes (eg, fatigue, depression), or anthropometric outcomes (eg, body mass index, waist circumference) were eligible for inclusion. Meta‐analyses were performed to estimate hazard ratios for the highest compared with the lowest levels of sedentary behavior for all‐cause and colorectal cancer‐specific mortality outcomes. The ROBINS‐E (Risk of Bias in Nonrandomized Studies‐of Exposures tool) and the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) system were used to assess the risk of bias and the strength of evidence, respectively. Results: Thirty‐three eligible publications from a total of 3569 identified articles were included in the review. A higher level of postdiagnosis sedentary behavior was associated with an increased risk of all‐cause mortality (hazard ratio, 1.22; 95% CI, 1.06‐1.41; heterogeneity [I2 statistic], 33.8%) as well as colorectal cancer‐specific mortality (hazard ratio, 1.53; 95% CI, 1.14‐2.06; I2, 0%). No clear or consistent associations between sedentary behavior and patient‐reported or anthropometric outcomes were identified. The risk of bias in individual studies ranged from moderate to serious, and the strength of evidence ranged from very low to low. Conclusions: Although avoiding high levels of sedentary behavior after a cancer diagnosis may improve survival, further research is required to help clarify whether the association is causal. Refereed/Peer-reviewed

Background:The ACTIVATE Trial examined the efficacy of a wearable-based intervention to increase physical activity and reduce sedentary behavior in breast cancer survivors. This paper examines the effects of the intervention on health-related quality of life (HRQoL) and fatigue at 12 weeks (T2; end of intervention) and 24 weeks(T3; follow-up). Methods:Inactive and postmenopausal women who had completed primary treatment for stage I-III breast cancer were randomized to intervention or wait list control.Physical activity and sedentary behavior were measured by Actigraph and activPAL accelerometers at baseline (T1), end of the intervention (T2), and 12 weeks follow-up(T3). HRQoL and fatigue were measured using the Functional Assessment of Cancer Therapy-Breast (FACT-B) and the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue). Primary intervention effects were evaluated comparing intervention and wait list group at T2 using repeated measures mixed effects models. Results:Overall, 83 women were randomized and trial retention was high (94%). A4.6-point difference in fatigue score was observed between groups at T2 (95% CI:1.3, 7.8) indicating improvement in fatigue profiles in the intervention group. In within groups analyses, the intervention group reported a 5.1-point increase in fatigue from baseline to T2 (95% CI: 2.0, 8.2) and a 3.3-point increase from baseline to T3 (95%CI: 0.1, 6.41). Conclusions:Despite small improvements in fatigue profiles, no effects on HRQoL were observed. While the ACTIVATE Trial was associated with improvements in physical activity and sedentary behavior, more intensive or longer duration interventions may be needed to facilitate changes in HRQoL Refereed/Peer-reviewed

The purpose of this study was to examine potential effects of reallocating time between sleep, sedentary and active behaviours on fatigue symptoms and quality of life in a sample of non-Hodgkin lymphoma survivors. Non-Hodgkin lymphoma survivors identified from the Western Australian Cancer Registry (N = 149) (response rate = 36%; median age = 64 years) wore an ActigraphA (R) GT3X+ accelerometer for 7 days and completed the Fatigue Scale, the Functional Assessment of Cancer Therapy-General and the Pittsburgh Sleep Quality Index. We used isotemporal substitution methods in linear regression models to examine the potential effects of reallocating time between sleep, sedentary and activity behaviours on fatigue and quality of life. Data collection was conducted in Western Australia in 2013. Significant differences were observed for fatigue symptoms when 30 min per day of bouted moderate-to-vigorous physical activity (10 min) was reallocated from 30 min per day of sleep (5.7 points, 95% CI = 1.8, 9.7), sedentary time bouts (20 min) (5.7 points, 95% CI = 1.6, 9.7), sedentary time non-bouts (5.1 points, 95% CI = 1.0, 9.3) or light intensity activity (5.5 points, 95% CI = 1.5, 9.5). Isotemporal substitution effects of reallocating sedentary time, sleep and light physical activity with bouted physical activity was significantly associated with fatigue, but not quality of life. Findings from the present study may aid in the development and delivery of health behaviour interventions that are more likely to influence the health outcome of interest. Refereed/Peer-reviewed

Background: The benefits of an active lifestyle after a breast cancer diagnosis are well recognized, but the majority of survivors are insufficiently active. The ACTIVATE Trial examined the efficacy of an intervention (use of the Garmin Vivo fit 2 activity monitor coupled with a behavioral feedback and goal-setting session and 5 telephone-delivered health coaching sessions) to increase moderate to vigorous physical activity (MVPA) and reduce sedentary behavior in breast cancer survivors. Methods: This randomized controlled trial recruited 83 inactive, postmenopausal women diagnosed with stage I-III breast cancer who had completed primary treatment. Participants were randomly assigned to the intervention group or to the control group, and the intervention was delivered over a 12-week period. MVPA and sedentary behavior were measured with Actigraph and activPAL accelerometers at baseline (T1) and at the end of the intervention (T2). Results: Retention in the trial was high, with 80 (96%) of participants completing T2 data collection. At T2, there was a significant between-group difference in MVPA (69 min/wk; 95% CI = 22-116) favoring the intervention group. The trial resulted in a statistically significant decrease in both total sitting time and prolonged bouts (≥20 min) of sitting, with between-group reductions of 37 min/d (95% CI = −72 to −2) and 42 min/d (95% CI = −83 to −2), respectively, favoring the intervention group. Conclusion: Results from the ACTIVATE Trial suggest that the use of wearable technology presents an inexpensive and scalable opportunity to facilitate more active lifestyles for cancer survivors. Whether or not such wearable technology-based interventions can create sustainable behavioral change should be the subject of future research. Refereed/Peer-reviewed

BACKGROUND: This brief report examines the maintenance of moderate to vigorous physical activity (MVPA) and sedentary behavior changes approximately 12 weeks after the delivery of the ACTIVATE Trial primary intervention (use of the Garmin Vivofit 2 activity tracker coupled with a behavioral feedback and goal-setting session and 5 telephone-delivered health coaching sessions). We also examine the efficacy of an abridged intervention (use of the Garmin Vivofit 2 only) in the wait list control group. METHODS:A pre-post design was employed to examine the secondary aims of the ACTIVATE Trial (n = 80; mean age = 62 years). MVPA and sedentary behavior were measured using Actigraph and activPAL accelerometers after delivery of the primary intervention (T2), and again 12 weeks later (T3). Linear mixed models with random effects were used to examine within-group changes in MVPA and sitting time variables. RESULTS: After the 12-week follow-up period, women in the primary intervention group had maintained their higher levels of MVPA (change from T2 to T3 = 14 min/wk; 95% CI = −18 to 46; P = .37). However, their sitting time increased slightly, by7 min/d (95% CI = −20 to 34; P = .58), but it did not return to its preintervention level. After receiving the Garmin Vivofit 2, the wait list control group increased their MVPA by 33 min/wk (95% CI = 3-64; P = .03) and reduced their sitting time by 38 min/d (95% CI = −69to −7; P = .02) over the same 12-week period. CONCLUSION: The secondary outcomes from the ACTIVATE Trial suggest that wearable technology may generate sustainable changes in MVPA and sitting time. Wearable technology alone may be sufficient to change behavior, at least in the short term. Refereed/Peer-reviewed

Purpose: The purpose of this study was to determine associations of objectively assessed moderate-to-vigorous intensity physical activity (MVPA) and sedentary time with psychological health outcomes including depression symptoms, anxiety symptoms, and overall satisfaction with life in colon cancer survivors. Methods: Colon cancer survivors (N = 180) from Alberta, Canada (n = 91), and Western Australia (n = 89) completed a mailed survey that assessed depression symptom severity, state anxiety, and satisfaction with life (SWL). Sedentary time and MVPA were assessed using the Actigraph ® GT3X+ accelerometer (60-s epochs) via a 7-day monitoring protocol. MVPA and sedentary time were corrected for wear time and then examined as quartiles (Q). Multivariate analysis of variance was used to examine associations of MVPA and sedentary time with psychological health. Results: There was a significant association between psychological health outcomes and objectively assessed MVPA [Wilks’ λ = 0.886, F(3382.2) = 2.156, p = 0.024] that suggested a small and significant association between MVPA and SWL (p = 0.032). A significant multivariate analysis of variance (MANOVA) [Wilks’ λ = 0.945, F(3159) = 3.1, p = 0.028] suggested participants meeting guidelines reported significantly fewer anxiety symptoms (M < inf > diff < /inf > = −1.23, p = 0.027) and higher perceptions of SWL (M < inf > diff < /inf > = 3.0, p = 0.008). No significant associations emerged for sedentary time [Wilks’ λ = 0.956, F(9382.3) = 0.788, p = 0.628]. Conclusions: Contrary to previously published research using self-reports, objectively assessed MVPA and sedentary time were not associated with depression symptoms. Objectively assessed MVPA was associated with SWL and anxiety outcomes in colon cancer survivors. Implications for Cancer Survivors: Colon cancer survivors should continue to engage in regular and sustained MVPA for the accrual of psychological health benefits. Refereed/Peer-reviewed

Objectives: No studies have examined objectively assessed physical activity, sedentary time, and patient-reported outcomes among lung cancer survivors. The objective of this study was to determine associations of objectively assessed moderate-to-vigorous intensity physical activity (MVPA) and sedentary time with health-related quality of life (HRQoL) and fatigue among lung cancer survivors. Materials and method: Lung cancer survivors in Southern Alberta (N = 540) were invited to complete a mailed survey that assessed HRQoL [Functional Assessment of Cancer Therapy-Lung (FACT-L)], physical and functional well-being [Trial Outcome Index (TOI)] , and fatigue [Fatigue Scale (FS)]. Physical activity and sedentary time data was collected using an Actigraph ® GT3X+ accelerometer that was worn on the hip for seven consecutive days. Quantile regression was used to examine associations of HRQoL and fatigue with physical activity and sedentary time at the 25th, 50th, and 75th HRQoL and fatigue percentiles. Results: A total of 127 lung cancer survivors participated for a 24% response rate (Mean age = 71 years; Mean time since diagnosis = 75 months). Total MVPA minutes was positively associated with fewer fatigue symptoms at the 25th percentile (β = 0.16, p = 0.046). Total sedentary time was inversely associated with HRQoL at the 75th percentile (β = −0.07, p = 0.014) and inversely associated with fatigue symptoms at the 50th percentile (β = −0.04, p = 0.009). Total sedentary time was also inversely associated with physical and functional well-being scores at the 25th (β = −0.07, p = 0.045), 50th (β = −0.07, p = 0.004) and 75th (β = −0.04, p = 0.035) percentiles. Conclusion: Across the HRQoL, fatigue, and physical and functional well-being distributions, sedentary time was inversely associated with HRQoL, fatigue, and physical and functional well-being in lung cancer survivors. Small associations were observed between MVPA and fatigue, but no associations emerged with HRQoL or physical and functional well-being. Refereed/Peer-reviewed

Background: In the cancer survivorship context, physical activity and sedentary behavior have been measured using different methods. Purpose: To conduct a narrative review of published research in cancer survivor populations to summarize the quality and identify gaps in reporting on accelerometer data collection, data processing, and outcome measures in cancer survivors. Methods: An initial PubMed® search of articles published in English was conducted in January 2017, and a final search was conducted in May 2017. Variables extracted included study characteristics, methods for accelerometry data collection (e.g., device used), data processing (e.g., cut points used), and data reporting (e.g., time spent in different activity intensities). Results: A total of 46 articles were eligible for inclusion in the review. The majority of studies (34 of 46) targeted a single cancer group and 18 of these 34 studies were in survivors of breast cancer. Half (54%) of the studies used an ActiGraph® accelerometer. Methods of accelerometer data processing varied across studies. Definitions of non–wear time, vectors used during processing, and filters applied during processing were reported by 51%, 60%, and 8% of studies, respectively. Most studies reported moderate and vigorous physical activity (78%), 50% reported sedentary time, and 43% reported light-intensity activity. Cut points to categorize these activities varied between studies. Conclusions: This narrative review highlights inconsistency in the methods used to collect, process, and report accelerometry data across cancer survivor studies. Accelerometry has potential to add detailed knowledge of the levels and patterns of physical activities and sedentary behaviors across the cancer spectrum. Recommendations are made to improve data processing and reporting methods to maximize the scientific validity of future accelerometer research in this field. Refereed/Peer-reviewed

Sitting has frequently been equated with smoking, with some sources even suggesting that smoking is safer than sitting. This commentary highlights how sitting and smoking are not comparable. The most recent meta-analysis of sedentary behavior and health outcomes reported a hazard ratio of 1.22 (95% confidence interval [CI] = 1.09, 1.41) for all-cause mortality. The relative risk (RR) of death from all causes among current smokers, compared with those who have never smoked, is 2.80 (95% CI = 2.72, 2.88) for men and 2.76 for women (95% CI = 2.69, 2.84). The risk is substantially higher for heavy smokers (> 40 cigarettes per day: RR = 4.08 [95% CI = 3.68, 4.52] for men, and 4.41 [95% CI = 3.70, 5.25] for women). These estimates correspond to absolute risk differences of more than 2000 excess deaths from any cause per 100 000 persons per year among the heaviest smokers compared with never smokers, versus 190 excess deaths per 100 000 persons per year when comparing people with the highest volume of sitting with the lowest. Conflicting or distorted information about health risks related to behavioral choices and environmental exposures can lead to confusion and public doubt with respect to health recommendations.

Physical activity may improve quality of life among kidney transplant recipients. Studies that have examined physical activity and sedentary time prevalence among kidney transplant recipients have used self-reported assessment tools, which may result in biased reporting. A better understanding of physical activity and sedentary patterns among transplant recipients is needed for the optimal design of targeted interventions. Purpose: To objectively assess physical activity and sedentary time profiles among kidney transplant recipients, and examine possible demographic and clinical correlates of physical activity and sedentary time. Methods: Transplant recipients (diagnosed between 1993-2016) were recruited from the Northern Alberta Renal Program’s Nephrology Information System database. Participants(N=133; 11% response rate) wore an Actigraph® GT3X+ accelerometer on their hip during waking hours for seven consecutive days. Commonly accepted activity count cutoffs(Freedson) were used to differentiate between sedentary, light, and moderate-to-vigorous intensity physical activity (MVPA). Accelerometer data were processed in 60-second epochs. Results: Participants’ average age was 58.4 years (SD=14.7), 57% were female, and the average duration since transplant was 27.2 months (SD=21.5). Participants wore their accelerometer for 6.5 days (SD=6.5). Participants recorded 9.4 (SD=4.1) hours per day of total sedentary time and averaged 3.7 bouts (SD=1.7) of sedentary time per day accumulated in at least 30-minute bouts, for a total of 2.9 hours (SD=1.5). For active behaviors, participants recorded 20.7 minutes of total MVPA per day and 5.7 minutes per day of MVPA accumulated in at least 10-minute bouts. Participants 60 years of age (Mean Δ=15.8 min/day, CI: 9.7 to 22, p

Objective: To determine demographic and clinical correlates of accelerometer assessed physical activity and sedentary time among a population-based sample of lung cancer survivors. Methods: Lung cancer survivors in Southern Alberta, Canada (N = 527) were invited to complete a mailed survey assessing socio-demographics and wear an Actigraph® GT3X+ accelerometer for 7 days. Average daily minutes of physical activity and sedentary time were derived from the accelerometer data. Accelerometer data were processed using standard Freedson cutpoints, and correlates of physical activity and sedentary time were determined with linear regression. Results: A total of 127 lung cancer survivors participated (mean age = 71 years), for a 24% response rate. Moderate-to-vigorous physical activity was negatively associated with being >60 years of age (β = −7.4, CI: −14.7, −0.10). Moderate-to-vigorous physical activity accumulated in 10-minute bouts was associated with receiving surgery and adjuvant chemotherapy (β = 9.1, CI: 2.1, 16.1). Sedentary time was associated with being >60 years of age (β = 32.4, CI: 3.1, 61.7), smoking (β = 63.9, CI: 22.5, 105.4), and being overweight/obese (β = 28.6, CI: 6.4, 50.1). Conclusion: Age, smoking history, and body mass index emerged as correlates of accelerometer assessed light, moderate, and vigorous physical activity, and sedentary time among lung cancer survivors. Implications for Cancer Survivors: Identifying correlates of physical activity and sedentary time may aid in the development of targeted behavioral interventions for this population. usc Refereed/Peer-reviewed

Objectives: The aims of this study were to describe the volume and patterns of objectively assessed sedentary behaviour, light intensity physical activity (LPA) and moderate-vigorous physical activity (MVPA), and to examine socio-demographic correlates, among adults living with type 2 diabetes. Methods: Participants (n = 166) wore an accelerometer (Actigraph® GT3X+) for seven consecutive days during waking hours and completed a questionnaire. Physical activity (PA) and sedentary time were described, and multivariable linear regression was used to estimate associations between sociodemographic characteristics and sedentary time and PA. Results: Participants, 46%of whom were female, had a mean age of 65.4 years (standard deviation (SD) = 9.5), body mass index (BMI) of 31.5 (6.6) kg/m 2 and had been living with diabetes for an average of 13.1 (7.6) years. Participants were sedentary for 543.6 minutes/day, spent 273.4 minutes/day and 22.4 minutes/day in LPA and MVPA respectively. BMI was associated with increased sedentary time and reduced LPA (−2.5 minutes/day, 95% CI: −4.33 to −0.70) and MVPA (−0.62 minutes/day, 95% CI: −1.05 to −0.18) time. Compared with males, females had more LPA (34.4 minutes/day, 95% CI: 10.21–58.49) and less MVPA (−6.2 minutes/day, 95% CI: −12.04 to −0.41) time. Unemployed participants had 30.05 minutes more MVPA (95% CI: 3.35–56.75) than those who were employed or homemakers, and those not reporting income had 13 minutes/day more MVPA time than participants in the lowest income category (95% CI: 3.46–22.40). Conclusion: Adults living with type 2 diabetes were not sufficiently active and were highly sedentary. Our results emphasize the need for more research exploring the diabetes-related health outcomes of sedentary behaviour and physical inactivity among people living with type 2 diabetes. Refereed/Peer-reviewed

Objectives: Few studies have measured the physical activity levels of non-Hodgkin lymphoma (NHL) survivors, and no previous studies have measured sedentary behavior levels in this population. This study used accelerometers to measure the physical activity and sedentary time levels of NHL survivors and examined the demographic, behavioral, and medical correlates of these behaviors. Methods: A total of 156 NHL survivors (mean age=64 years) completed a questionnaire and wore an accelerometer for seven consecutive days during waking hours. Descriptive statistics were used to describe physical activity and sedentary time levels, and linear regression was used to investigate correlates of these behaviors. Results: Participants averaged 8.6 h of sedentary time per day (60% of their accelerometer wear time), 5.3 h of light-intensity physical activity (37%), and 30 min of moderate-intensity physical activity (3%). Only 12% of the participants accrued the duration of moderate-vigorous physical activity recommended by physical activity guidelines (30 min accrued in bouts of at least 10 min). Female participants, older participants, smokers, and participants with larger waist circumference had lower levels of moderate-to-vigorous intensity physical activity. Smokers and participants with larger waist circumference also had higher sedentary time levels. Conclusion: The NHL survivors in this study spent the majority of their waking hours sedentary, and few met physical activity guidelines. The results of this study emphasize the need for more research exploring the health consequences of sedentary behavior and physical inactivity in NHL survivors. Refereed/Peer-reviewed

Background: Moderate-to-vigorous intensity physical activity (MVPA) is inversely associated with waist circumference and body mass index (BMI) among breast cancer survivors. Limited research has focused on behaviors that account for larger portions of the day [sleep, sedentary time, and light-intensity physical activity (LPA)]. We investigated the interdependent associations of self-reported sleep, objectively assessed prolonged and short bouts of sedentary time, total LPA, and total MVPA with waist circumference and BMI. Methods: A cross-sectional sample of breast cancer survivors (N = 256, mean age = 60 years; mean time since diagnosis = 3 years) wore an Actigraph GT3X+ accelerometer during waking hours for 7 days. Participants completed the Pittsburgh Sleep Quality Index and self-reported their waist circumference, height, and weight. An isotemporal substitution approach was used in linear regression models to explore the associations of reallocating time to sleep, sedentary and active behaviors on waist circumference, and BMI, after adjusting for potential confounders. Results: Reallocating 30 minutes to MVPA was significantly associated with lower waist circumference when allocated from sleep (−2.50 cm), prolonged sedentary time (−2.51 cm), or LPA (−2.71 cm). Reallocating 30 minutes of prolonged sedentary time to nonprolonged sedentary time was significantly associated with lower waist circumference (−0.94 cm). Similar results were observed for BMI. Conclusions: Reallocating 30 minutes to MVPA was associated with significantly lower waist circumference and BMI, as was reallocating 30 minutes of prolonged sedentary time to 30 minutes of nonprolonged sedentary time. Impact: Increasing MVPA levels and decreasing time spent in prolonged, unbroken sedentary bouts may be avenues for improving body composition in this population. Cancer Epidemiol Biomarkers Prev; 26(2); 254–60. ©2016 AACR.

Objective: To assess differences in accelerometer-assessed moderate-to vigorous-intensity physical activity (MVPA), light-intensity physical activity, and sedentary time between cancer survivors and adults without cancer. Patients and Methods: Accelerometer data collected from 241 breast cancer survivors (ACCEL-Breast study, 2013) and 171 colon cancer survivors (ACCEL-Colon study, 2012-2013) were pooled with data collected from adults without cancer (Australian Diabetes, Obesity and Lifestyle accelerometer sub-study, 2011-2012). Linear regression was used to estimate differences in physical activity and sedentary behavior levels between cancer survivors and adults without cancer, adjusted for potential confounding factors. Results: The mean MVPA was significantly higher among breast cancer survivors than among females who had not had cancer (29 vs 22 min/d; P

Physical activity is recommended for kidney transplant recipents as it may improve outcomes including mortality, exercise capacity, muscle strength, and health-related quality of life.The objective of this study was to examine accelerometer-based physical activity and sedentary time profiles among kidney transplant recipients and examine possible demographic and clinical correlates of physical activity and sedentary time.Cross-sectional.Edmonton, Alberta, Canada.Kidney transplant recipients were recruited (N = 1,284) from the Northern Alberta Renal Program's Nephrology Information System database (1993-2016).Participants wore an ActiGraph GT3X+ accelerometer on their hip during waking hours for seven consecutive days.Kidney transplant recipients (1993-2016) recruited from the Northern Alberta Renal Program's Nephrology Information System database wore an accelerometer and completed a self-reported questionnaire. Multiple linear regression was used to determine associations between activity level, demographic, and clinical characteristics.Participants' (n = 133; 11% response rate) mean age (SD) was 58 (14) years and 56% were female. Mean total sedentary time was 9.4 (1.4) hours per day; total moderate-to-vigorous physical activity (MVPA) time was 20.7 (19.6) minutes per day. MVPA was significantly associated with age where each additional year was associated with 0.48 fewer min/day (ie, ~30 seconds) (unstandardized beta:Limitations include the cross-sectional design, poor response rate, and limited generalizability of the results.Kidney transplant recipients showed high volumes of sedentary time and low volumes of health-enhancing physical activity. Understanding correlates of these behaviors may aid in the development of interventions to favorably change these behaviors.L’activité physique est recommandée aux receveurs d’une greffe rénale puisqu’elle peut améliorer leur santé — augmentation de la tolérance à l’effort, de la force musculaire et de la qualité de vie liée à l’état de santé — et limiter les issues indésirables, notamment la mortalité.L’objectif était double: caractériser l’activité physique et le profil de sédentarité des receveurs d’une greffe rénale avec un accéléromètre, et analyser les possibles corrélations démographiques et cliniques de l’activité physique et du comportement sédentaire.Étude transversale.Edmonton, en Alberta (Canada).Des patients ayant reçu une greffe rénale entre 1993 et 2016 (n = 1284) et recrutés dans la base de données du système d’information en néphrologie du Northern Alberta Renal Program (NARP).Les participants portaient un accéléromètre Actigraph GT3X+ à la hanche durant les heures d’éveil pour sept jours consécutifs.Les receveurs d’une greffe rénale (1993 à 2016) recrutés dans la base de données du système d’information en néphrologie du NARP ont porté un accéléromètre et rempli un questionnaire d’auto-déclaration. Une régression linéaire multiple a été employée pour établir les associations entre le niveau d’activité physique et les données démographiques et cliniques des patients.Les participants (n = 133; taux de réponse de 11 %), dont 56 % étaient des femmes, étaient âgés de 58 ans en moyenne (écart-type [É-T]: 14 ans). La période de sédentarité s’élevait en moyenne à 9,4 heures par jour (É-T: 1,4 heure), alors que la période moyenne d’activité physique modérée à vigoureuse (APMV) s’établissait à 20,7 minutes par jour (É-T: 19,6 minutes). L’APMV a été associée de façon significative à l’âge du patient, où chaque année additionnelle en âge a correspondu à une réduction de 0,48 minute par jour (environ 30 sec.) de l’APMV (bêta non normalisé [La généralisation des résultats est limitée par la nature transversale de l’étude et par le faible taux de réponse.Les receveurs d’une greffe rénale sont largement sédentaires et pratiquent peu d’activité physique ayant un effet bénéfique sur leur santé. La compréhension des corrélations de ces comportements pourrait faciliter le développement d’interventions visant à les modifier favorablement.

Physical activity (PA) and sedentary behavior may influence the physical and mental health of breast cancer survivors; however, few studies have objectively measured these behaviors in this population. We used accelerometers to measure the PA and sedentary time levels of breast cancer survivors and examined the demographic, behavioral, and medical correlates of these behaviors using two complementary approaches. A total of 259 breast cancer survivors wore an accelerometer for 7 days during waking hours and completed a questionnaire. We used linear regression and classification trees to investigate correlates of PA and sedentary time. The breast cancer survivors in this study (mean age = 61 years, mean time since diagnosis = 3 years) were sedentary for a daily average of 8.2 h, in light-intensity PA for 5.8 h and in moderate-to-vigorous intensity PA (MVPA) for 32 min, with 16 % meeting PA guidelines. Participants with high comorbidity were the least likely to be meeting guidelines (0 %), while a subgroup of participants with no/low comorbidity, a university degree, and higher levels of pre-diagnosis MVPA were the most likely to be meeting guidelines (47 %). Older participants (70+ years) were the most likely to have sedentary time levels at least twice as high as activity levels, while participants who were younger than 70 years and not in the lowest category of pre-diagnosis MVPA were the least likely. Interventions to facilitate physical activity and reduce sedentary time among breast cancer survivors should consider comorbidity status and previous PA experience. Refereed/Peer-reviewed

Refereed/Peer-reviewed

Research conducted on the general population indicates self-reported measures of physical activity and sedentary behaviour are inaccurate when compared with objective measures; however, it is not clear if this also applies to cancer survivors. In this study, we compared accelerometer-based and self-reported measures of moderate- to vigorous-intensity physical activity (MVPA) and sedentary time among colon cancer survivors. A total of 176 colon cancer survivors, recruited from the Western Australia and Alberta cancer registries, wore an Actigraph GT3X+ accelerometer for 7 days and completed self-reported questions about recent MVPA (Godin Leisure-Time Exercise Questionnaire) and usual sedentary time (Marshall Domain-Specific Sitting Questionnaire). Accelerometer data were processed using 60-s epochs and summarized using Freedson's cut points. Spearman's rho and intraclass correlation coefficients (ICCs) were used to assess correlation and agreement for daily MVPA and sedentary time estimates from the two methods. Total mean minutes per day spent in MVPA was 12 min based on accelerometer data and 26 min based on self-reported data (P (Difference) < 0.01). Correlation between the methods was fair (rho = 0.51); however, agreement was poor (ICC = 0.33). Mean daily time spent sedentary was similar in both methods (similar to 8.5 h); however, both correlation and agreement were poor (rho = 0.19, ICC = 0.16). We found fair correlation but poor agreement between the self-reported and accelerometer-based assessments of MVPA used in this study. For sedentary time, both correlation and agreement between the two methods were poor. Studies of colon cancer survivors using these self-report measures are likely to have a considerable amount of exposure misclassification. Refereed/Peer-reviewed

BACKGROUND: The primary purpose of this study was to determine associations of accelerometer-assessed moderate- to vigorousintensity physical activity (MVPA) and sedentary time with health-related quality of life (HRQoL) and physical function and well-being in colon cancer survivors. METHODS: Colon cancer survivors (N=178) from Alberta, Canada (n=92) and Western Australia (n=86) completed a mailed survey that assessed HRQoL (Functional Assessment of Cancer Therapy-Colorectal), physical function and wellbeing (Trial Outcome Index-Colorectal), and relevant covariates. MVPA and sedentary time were assessed using the Actigraph GT3X1 accelerometer (60-second epochs) via a 7-day monitoring protocol. Average daily MVPA and sedentary time was corrected for wear time and then examined as quartiles. RESULTS: Adjusting for relevant demographic, behavioral, and clinical covariates, a significant difference in HRQoL scores emerged between quartile 1 (Q1) and Q4 (M diff =11.5, P=.038). For physical function and wellbeing, a significant difference emerged between Q1 and Q4 (M diff =9.1, P=.009). For fatigue, a significant difference emerged between Q1 and Q4 (M diff =7.1, P=.05). Significant differences were also observed for between Q1 and Q3 (M diff =2.4, P=.041), and Q1 and Q4 (M diff =3.5, P=.002) for colorectal cancer-specific symptoms. There were no statistically significant associations of sedentary time with HRQoL, physical function and well-being, fatigue, or colorectal cancer-specific symptoms. CONCLUSIONS: Objectively measured MVPA, but not sedentary time, was associated with better HRQoL, physical function and well-being, and colorectal cancer- specific symptoms in colon cancer survivors. For MVPA, differences met or exceeded contemporary cutpoints for determining clinically important differences. Refereed/Peer-reviewed