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(1) Background: A healthful diet, regular physical activity, and weight management are cornerstones for cancer prevention and control. Yet, adherence is low in cancer survivors and others, calling for innovative solutions. Daughters, dUdes, mothers, and othErs fighting cancer Together (DUET) is a 6-month, online, diet-and-exercise, weight-loss intervention to improve health behaviors and outcomes among cancer survivor-partner dyads. (2) Methods: DUET was tested in 56 dyads (survivors of obesity-related cancers and chosen partners) (n = 112), both with overweight/obesity, sedentary behavior, and suboptimal diets. After baseline assessment, dyads were randomized to DUET intervention or waitlist control arms; data were collected at 3- and 6-months and analyzed using chi-square, t-tests, and mixed linear models (α < 0.05). (3) Results: Retention was 89% and 100% in waitlisted and intervention arms, respectively. Dyad weight loss (primary outcome) averaged −1.1 (waitlist) vs. −2.8 kg (intervention) (p = 0.044/time-by-arm interaction p = 0.033). Caloric intake decreased significantly in DUET survivors versus controls (p = 0.027). Evidence of benefit was observed for physical activity and function, blood glucose, and c-reactive protein. Dyadic terms were significant across outcomes, suggesting that the partner-based approach contributed to intervention-associated improvements. (4) Conclusions: DUET represents a pioneering effort in scalable, multi-behavior weight management interventions to promote cancer prevention and control, calling for studies that are larger in size, scope, and duration.

Background Existing evidence suggests that there is an association between body size and prevalent Benign Prostatic Hyperplasia (BPH)-related outcomes and nocturia. However, there is limited evidence on the association between body size throughout the life-course and incident BPH-related outcomes. Methods Our study population consisted of men without histories of prostate cancer, BPH-related outcomes, or nocturia in the intervention arm of the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO) (n = 4710). Associations for body size in early- (age 20), mid- (age 50) and late-life (age ≥ 55, mean age 60.7 years) and weight change with incident BPH-related outcomes (including self-reported nocturia and physician diagnosis of BPH, digital rectal examination-estimated prostate volume ≥ 30 cc, and prostate-specific antigen [PSA] concentration > 1.4 ng/mL) were examined using Poisson regression with robust variance estimation. Results Men who were obese in late-life were 25% more likely to report nocturia (Relative Risk (RR): 1.25, 95% Confidence Interval (CI): 1.11–1.40; p-trendfor continuous BMI overweight: 1.13, 95% CI 1.07–1.21; RRobese: 1.10, 95% CI 1.02–1.19; p-trendfor continuous BMI = 0.017) as compared to normal weight men. Obesity at ages 20 and 50 was similarly associated with both nocturia and prostate volume ≥ 30 cc. Considering trajectories of body size, men who were normal weight at age 20 and became overweight or obese by later-life had increased risks of nocturia (RRnormal to overweight: 1.09, 95% CI 0.98–1.22; RRnormal to obese: 1.28, 95% CI 1.10–1.47) and a prostate volume ≥ 30 cc (RRnormal to overweight: 1.12, 95% CI 1.05–1.20). Too few men were obese early in life to examine the independent effect of early-life body size. Later-life body size modified the association between physical activity and nocturia. Conclusions We found that later-life body size, independent of early-life body size, was associated with adverse BPH outcomes, suggesting that interventions to reduce body size even late in life can potentially reduce the burden of BPH-related outcomes and nocturia.

A large majority of irritable bowel syndrome (IBS) and dual-diagnosis IBS and inflammatory bowel disease (IBD) patients report that symptoms originate from or are exacerbated by "trigger foods." Despite patient interest and need, there is no consensus on what diet is optimal. Popular diets have notable limitations including cost, length, implementation complexity and lack of personalization.This pilot study evaluated the feasibility, desirability, and impact on gastrointestinal symptoms of a digitally delivered personalized elimination diet for IBS and co-morbid IBS/IBD patients, powered by machine learning. Participants were recruited online and were provided access to a digital, personalized nutrition tool for 9 weeks (N = 37; IBS-only = 16, Crohn's Disease and IBS = 9, Ulcerative Colitis and IBS = 12).Significant symptom improvement was seen for 81% of participants at study midpoint and persisted for 70% at endpoint, measured by the relevant symptom severity score (IBS Symptom Severity Score IBS-SSS, Patient Simple Clinical Colitis Activity Index P-SCCAI or Mobile Health Index for CD, mHI-CD). Clinically significant symptom improvement was observed in 78% of participants at midpoint and 62% at endpoint. Twenty-five participants (67.6%) achieved total symptomatic resolution by end of study. Patient-reported quality of life (QoL) improved for 89% of participants. Ninety-five percent daily engagement, 95% retention, 89% adherence and 92% satisfaction with the program were reported.Dietary elimination can improve symptoms and QoL in patients with IBS and co-morbid IBS/IBD. Digital technology can personalize dietary interventions and improve adherence. Randomized controlled trials are warranted.

Digital health has grown from a collection of provocative ideas into a multibillion-dollar industry in just over a decade in part because of the promise of this technology for improving physical activity monitoring and promotion strategies. Systematic reviews and meta-analyses of evidence for this technology are beginning to accumulate.1 2 In this commentary, we offer some important considerations as the field moves towards creating personalised strategies for promoting physical activity. First, apps and wearable trackers are often portrayed as tools for promoting physical activity, but, by themselves, they are not treatments. They are simply vehicles for delivering the psychologically active ingredients of behaviour change, akin to the capsule that encloses pharmacologically active agents in medication. Physicians do not prescribe medication based on the delivery vehicle alone; they consider the mechanism of dysfunction to target, active ingredients in the drug and dosing to inform treatments. It is inappropriate to conclude that digital tools promote positive changes in activity; poorly designed interventions deployed via digital modes are no more than a digital placebo—they lack a defined target or active ingredient but are delivered in a shiny new capsule. Second, between-group differences in treatment and control groups are …

Weight gain in adulthood is a risk factor for breast cancer; however, the impact on age of onset is unknown. The objective of this study was to investigate whether weight gain from early- to mid-adulthood influenced the timing of breast cancer onset. Increase in body mass index (BMI) from lowest adult BMI to BMI at diagnosis and age at which these events occurred were calculated from breast cancer survivors enrolled in a weight loss trial (n = 660). Quartiles (Q) of the average increase in BMI were determined and associations between weight gain and age at disease onset were analyzed using analysis of covariance and spline regression models. A significant linear trend was observed across the quartiles of BMI change for earlier age at diagnosis [Q1 52.3 (± 0.73), Q2 51.9 (± 0.70), Q3 49.6 (± 0.66), Q4 47.3 (± 0.67), p

Background To examine one-year trajectories of urinary and sexual outcomes, and correlates of these trajectories, among prostate cancer patients treated by radical prostatectomy (RP). Methods Study participants were recruited from 2011 to 2014 at two US institutions. Self-reported urinary and sexual outcomes were measured at baseline before surgery, and 5 weeks, 6 months and 12 months after surgery, using the modified Expanded Prostate Cancer Index Composite-50 (EPIC-50). Changes in EPIC-50 scores from baseline were categorized as improved (beyond baseline), maintained, or impaired (below baseline), using previously-reported minimum clinically important differences. Results Of the 426 eligible participants who completed the baseline survey, 395 provided data on at least one EPIC-50 sub-scale at 5 weeks and 12 months, and were analyzed. Although all mean EPIC-50 scores declined markedly 5 weeks after surgery and then recovered to near (incontinence-related outcomes) or below (sexual outcomes) baseline levels by 12 months post-surgery, some men experienced improvement beyond their baseline levels on each sub-scale (3.3–51% depending on the sub-scale). Having benign prostatic hyperplasia (BPH) at baseline (prostate size ≥ 40 g; an International Prostate Symptom Index Score ≥ 8; or using BPH medications) was associated with post-surgical improvements in voiding dysfunction-related bother at 5 weeks (OR = 3.9, 95% CI: 2.1–7.2) and 12 months (OR = 3.3, 95% CI: 2.0–5.7); and in sexual bother at 5 weeks (OR = 5.7, 95% CI:1.7–19.3) and 12 months (OR = 3.0, 95% CI: 1.2–7.1). Conclusions Our findings provide additional support for considering baseline BPH symptoms when selecting the best therapy for early-stage prostate cancer.

Mounting evidence suggests that weight management and physical activity (PA) improve overall health and well being, and reduce the risk of morbidity and mortality among cancer survivors. Although many opportunities exist to include weight management and PA in routine cancer care, several barriers remain. This review summarizes key topics addressed in a recent National Academies of Science, Engineering, and Medicine workshop entitled, "Incorporating Weight Management and Physical Activity Throughout the Cancer Care Continuum." Discussions related to body weight and PA among cancer survivors included: 1) current knowledge and gaps related to health outcomes; 2) effective intervention approaches; 3) addressing the needs of diverse populations of cancer survivors; 4) opportunities and challenges of workforce, care coordination, and technologies for program implementation; 5) models of care; and 6) program coverage. While more discoveries are still needed for the provision of optimal weight-management and PA programs for cancer survivors, obesity and inactivity currently jeopardize their overall health and quality of life. Actionable future directions are presented for research; practice and policy changes required to assure the availability of effective, affordable, and feasible weight management; and PA services for all cancer survivors as a part of their routine cancer care. CA Cancer J Clin 2018;68:64-89. © 2017 American Cancer Society.

PURPOSE: The purpose of this study was to determine the association of marital status, a marker of social support, with all-cause and prostate cancer-specific mortality in a cohort of men with early-stage prostate cancer treated with radical prostatectomy. METHODS: We conducted a retrospective cohort study of 3579 men treated for localized (stage 1–2) prostate cancer with radical prostatectomy at a single institution between 1994 and 2004. Marital status (not married vs. married) and marital history (never married, divorced, widowed vs. married) at the time of prostatectomy were examined in relation to (1) all-cause mortality and (2) prostate cancer-specific mortality using Cox proportional hazards regression. RESULTS: Not being married (vs. married) at the time of radical prostatectomy was associated with an increased risk of all-cause mortality (Hazard Ratio (HR): 1.42; 95% Confidence Interval (CI): 1.10, 1.85). Similarly, in analyses of marital history, never married men were at highest risk of all-cause mortality (HR: 1.77, 95% CI: 1.19, 2.63). Unmarried status (vs. married) was also associated with an increased risk of prostate cancer-specific mortality (HR: 1.97; 95% CI: 1.01, 3.83). CONCLUSIONS: Unmarried men with prostate cancer were at greater risk for death after radical prostatectomy. Among married men with prostate cancer, marriage likely serves as a multi-faceted proxy for many protective factors including social support. Future studies should explore the mechanisms underlying these findings to inform the development of novel prostate cancer survival interventions for unmarried men and those with low social support.

Background No prior study has measured or compared self‐reported and objectively measured physical activity trajectories in prostate cancer survivors before and after treatment. Methods Clinically localized prostate cancer patients treated with radical prostatectomy were recruited between 2011 and 2014. Of the 350 participants enrolled at the main site, 310 provided self‐reported physical activity at baseline before radical prostatectomy, and 5 weeks, 6 months, and 12 months after radical prostatectomy. A subset of participants (n = 81) provided objectively measured physical activity at all study time points by wearing an accelerometer for 7 days each. Changes in activity over time were compared using Friedman’s test. Agreement between self‐reported and objective measures was evaluated using Spearman’s rank correlation coefficient. Results Self‐reported moderate‐to‐vigorous physical activity was high at baseline (median, 32.1 min/day), followed by a decline at 5 weeks (median, 15.0 min/day) and a recovery at 6 and 12 months (median, 32.1‐47.1 min/day). In contrast, objectively measured moderate‐to‐vigorous physical activity was low at all 4 time points (median, 0.0‐5.2 min/day), with no overall change across study assessments (global P = .29). Self‐reported moderate‐to‐vigorous physical activity tended to be more closely related to objectively measured light‐intensity physical activity (ρ = 0.29‐0.42) than to objectively measured moderate‐to‐vigorous physical activity (ρ = 0.07‐0.27, P = .009‐.32). Conclusions In our population of prostate cancer survivors with critically low moderate‐to‐vigorous physical activity levels, self‐reported measures greatly overestimated moderate‐to‐vigorous physical activity and may have been more reflective of light‐intensity physical activity. Because cancer survivor guidelines are derived from self‐reported data, our findings may imply that intensities of physical activity below moderate, such as light intensity, still have health benefits., In a population of 81 prostate cancer survivors with critically low moderate‐to‐vigorous physical activity levels, self‐reported measure greatly overestimates moderate‐to‐vigorous physical activity and may be more reflective of light‐intensity physical activity. Because prostate cancer guidelines are derived from self‐reported moderate‐to‐vigorous physical activity, the findings imply that lower intensities of physical activity, such as light‐intensity physical activity, may still have health benefits.

PURPOSE: Although many factors have been proposed to trigger symptom exacerbations (“flares”) in patients with interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome, few studies have investigated these factors empirically. Therefore, we embedded a case-crossover study in the Multidisciplinary Approach to the Study of Chronic Pelvic Pain longitudinal study to evaluate a range of patient-reported triggers. MATERIALS AND METHODS: Exposure to proposed triggers (diet, physical activities, sedentary behaviors, stress, sexual activities, infection-like symptoms, and allergies) was assessed by questionnaire a maximum of three times when participants reported flares and at three randomly-selected times. Participants’ pre-flare to -non-flare exposures were compared by conditional logistic regression. RESULTS: In our full analytic sample (n=292 participants), only two factors, recent sexual activity (odds ratio (OR)=1.44, 95% confidence interval (CI): 1.06–1.96) and symptoms of a urinary tract infection (OR=3.39, 95% CI: 2.02–5.68), which may overlap with those of flares, were associated with flare onset. In sub-analyses restricted to flares with specific, suspected triggers, additional positive associations were observed for some (certain dietary factors, abdominal muscle exercises, and vaginal infection-like symptoms and fever), but not other (e.g., stress) factors. CONCLUSIONS: With the exception of sexual activity, our findings suggest that patient-reported triggers may be either individual/group-specific or may not contribute to flares. These findings suggest caution in following rigid, global flare prevention strategies and support additional research to develop evidence-based strategies.

Text messaging is a promising means of intervening on an array of health issues among varied populations, but little has been published about the development of such interventions. The authors describe the development and implementation of an interactive text messaging campaign for parents to support behavior change among children in a childhood obesity randomized controlled trial. The authors invited 160 parents to participate in a text messaging intervention that provided behavior change support in conjunction with health coaching phone calls and mailed materials on behavioral goals. Throughout the 1-year intervention, the authors sent 1-2 text messages per week. The first asked how the child did with a target behavior the day before; parents who replied received an immediate feedback message tailored to their response. The second included a tip about how to work toward a behavioral goal. Baseline surveys indicate that text messaging is a common means of communication for parents, and many are willing to use text messaging to support behavior change for their child. Results at 1 year indicate a high level of engagement with the text messaging intervention, with nearly two thirds responding to 75% or more of the questions they were sent by text.

Physical activity is associated with reduced risk and progression of breast cancer, and exercise can improve physical function, quality of life, and fatigue in cancer survivors. Evidence on factors associated with cancer survivors’ adherence to physical activity guidelines from the American Cancer Society and the U.S. Department of Health and Human Services is mixed. This study seeks to help fill this gap in knowledge by examining correlates with physical activity among breast cancer survivors. Overweight or obese breast cancer survivors (N = 692) were examined at enrollment into a weight loss intervention study. Questionnaires and medical record review ascertained data on education, race, ethnicity, menopausal status, physical activity, and medical history. Measures of anthropometrics and fitness level were conducted. Regression analysis examined associations between physical activity and demographic, clinical, and lifestyle factors. Overall, 23 % of women met current guidelines. Multivariate analysis revealed that body mass index (p = 0.03), emergency room visits in the past year (p = 0.04), and number of comorbidities (p = 0.02) were associated with less physical activity. Geographic region also was associated with level of physical activity (p = 0.02), with women in Alabama reporting significantly less activity than those in other participating regions. The majority of overweight/obese breast cancer survivors did not meet physical activity recommendations. Physical activity levels were associated with degree of adiposity, geographic location, and number of comorbidities. The majority of overweight breast cancer survivors should be encouraged to increase their level of physical activity. Individualizing exercise prescriptions according to medical comorbidities may improve adherence.

Background: The importance of bone health among postmenopausal breast cancer survivors cannot be overemphasized. In addition to bone loss due to aging, secondary bone loss resulting from treatment is a major concern. Although weight loss has adverse effects on bone health in postmenopausal women without cancer, the impact of weight loss on bone health in postmenopausal women with breast cancer is not known. Our objective in this study was to evaluate the effect of weight loss on bone health among overweight/obese postmenopausal breast cancer survivors participating in a weight loss trial. Methods: We conducted this study in a subset of women (postmenopausal, N=81) enrolled in the multi-site Exercise and Nutrition to Enhance Recovery and Good health for You (ENERGY) study. The ENERGY study is a randomized controlled clinical trial designed to achieve a sustained ≥7% loss in body weight among overweight/obese breast cancer survivors with stage I, II or IIIA disease. Weight loss was achieved largely through dietary modification with the addition of physical activity. Bone health was assessed in a subset of women at a single site using bone turnover markers (BTMs) and dual energy X-ray absorptiometry (DXA). Markers of bone formation: osteocalcin, bone-specific alkaline phosphatase (BALP), procollagen type I N-terminal propeptide (PINP) and bone resorption: N-telopeptides of type-I collagen (NTX), C-terminal telopeptide (CTX) were quantified in blood samples collected at baseline, 6 month and 12-month follow-up. DXA T-score was used to measure bone mineral density at baseline and at 12-month follow-up. Generalized estimating equations were used to assess differences in mean values over time as well as from baseline to 6- and 12-month follow-up. Data from intervention and control arm women were used and treated as a cohort. Results: The mean age and body mass index (BMI) of women enrolled in our sub-study were 56 years and 31.6kg/m2, respectively. Majority (54.3%) had stage 2 disease. Mean weight decreased by 5.6 pounds between baseline and 6-month follow-up and 4.3 pounds between baseline and 12-month follow-up. There were statistically significant decreases in mean osteocalcin (2.0ng/ml, p-value 12-month follow-up. Weight change from baseline to 12-month follow-up was weakly inversely associated with changes in DXA T-score (r=-0.25, p-value=0.04) and CTX (r=-0.22, p-value=0.07) but not with other BTMs over the same time period. Conclusion: Weight loss over a 12-month period was associated with decreases in markers of bone formation and resorption but no changes in BMD in overweight/obese postmenopausal women with stage I, II or IIIA breast cancer. Further studies on the association of weight loss and the possible modifying effect of physical activity are needed in order to personalize weight control strategies in overweight/obese breast cancer survivors. Citation Format: Adetunji T Toriola, Jingxia Liu, Patricia A Ganz, Graham A Colditz, Lin Yang, Sonya Izadi, Anna L Schwartz, Kathleen Y Wolin. Weight loss and bone health in postmenopausal breast cancer survivors [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-09-33.

Objective The purpose of this analysis was to examine the correlates of the physical and psychosocial domains of quality of life (QOL) in a cohort of breast cancer survivors participating in a weight loss intervention trial. Methods Correlates of QOL and psychosocial functioning were examined in 692 overweight or obese breast cancer survivors at entry into a weight loss trial. QOL was explored with three measures: Short-form 36 (SF-36), Impact of Cancer scale (IOC), and the Breast Cancer Prevention Trial (BCPT) symptom scales. Available data included information on weight and physical activity, as well as demographic and medical characteristics. Multivariate analyses were used to identify associations adjusted for other characteristics. Results In multivariate analysis, younger age was associated with higher negative impact scores (p

Mounting evidence suggests that weight management and physical activity (PA) improve overall health and well being, and reduce the risk of morbidity and mortality among cancer survivors. Although many opportunities exist to include weight management and PA in routine cancer care, several barriers remain. This review summarizes key topics addressed in a recent National Academies of Science, Engineering, and Medicine workshop entitled, "Incorporating Weight Management and Physical Activity Throughout the Cancer Care Continuum." Discussions related to body weight and PA among cancer survivors included: 1) current knowledge and gaps related to health outcomes; 2) effective intervention approaches; 3) addressing the needs of diverse populations of cancer survivors; 4) opportunities and challenges of workforce, care coordination, and technologies for program implementation; 5) models of care; and 6) program coverage. While more discoveries are still needed for the provision of optimal weight-management and PA programs for cancer survivors, obesity and inactivity currently jeopardize their overall health and quality of life. Actionable future directions are presented for research; practice and policy changes required to assure the availability of effective, affordable, and feasible weight management; and PA services for all cancer survivors as a part of their routine cancer care. CA Cancer J Clin 2018;68:64-89. © 2017 American Cancer Society.

We evaluated agreement between patient reported urinary function and bother, and sexual function and bother in patients treated with radical prostatectomy to help inform possible nonfunctional, modifiable mechanisms for patient bother.Patients were recruited from 2011 to 2014 at Washington University, and Brigham and Women's Hospital. Urinary and sexual outcomes were assessed by EPIC-50 (Expanded Prostate Cancer Index Composite-50) before, 5 weeks and 12 months after radical prostatectomy. Spearman rank correlation coefficients and agreement/disagreement categories were used to describe the relation between function and bother.Despite moderate to good agreement between function and bother (urinary r = 0.51-0.69 and sexual r = 0.65-0.80) discordant groups were observed. In the urinary domain these groups were men disproportionately bothered by function at baseline (16.9%) and 12 months after radical prostatectomy (6.1%) and men less bothered by function 5 weeks (26.8%) and 12 months (9.9%) after radical prostatectomy. Discordant groups in the sexual domain were men less bothered by function at baseline (20.8%), and 5 weeks (21.1%) and 12 months (15.7%) after radical prostatectomy. Splitting the urinary bother scale into 2 subscales, including one for incontinence related bother to complement the urinary function scale which measures only incontinence, and one for voiding dysfunction related bother yielded considerably better agreement (urinary function and incontinence related bother r = 0.78-0.83). Factors contributing to the group less bothered by sexual function were unclear.When using EPIC-50, investigators should consider splitting the urinary bother scale by the relation to incontinence to prevent distortions of function-bother and comparisons before vs after radical prostatectomy by coexisting voiding dysfunction.

Background:The number of cancer survivors is increasing rapidly; however, little is known about whether engaging in physical activity after a cancer diagnosis is associated with lower mortality rates in men.Methods:We conducted a prospective cohort study of 1021 men (mean age, 71.3 years) who were diagnosed with cancer (other than nonmelanoma skin cancer). Men reported their physical activities (walking, stair climbing, and participation in sports and recreational activities) on questionnaires in 1988, a median of 6 years after their cancer diagnosis. Physical activity was updated in 1993 and men were followed until 2008, with mortality follow-up > 99% complete, during which 777 men died (337 from cancer, 190 from cardiovascular disease).Results:In multivariate analyses, the relative risks for all-cause mortality associated with expending < 2100, 2100–4199, 4200–8399, 8400–12,599, and ≥ 12,600 kJ/week in physical activity were 1.00 (referent), 0.77, 0.74, 0.76, and 0.52, respectively (P-trend < 0.0001). Higher levels of physical activity also were associated with lower rates of death from cancer and cardiovascular disease (P-trend = 0.01 and 0.002, respectively).Conclusions:Engaging in physical activity after cancer diagnosis is associated with better survival among men.

Purpose Since 1999, in conjunction with the internationally known and award-winning Your Disease Risk (yourdiseaserisk.org) risk assessment tool, the “Eight Ways to Stay Healthy and Prevent Cancer” message campaign has provided an evidence-based, but user-friendly, approach to cancer prevention. The scientific evidence behind the campaign is robust and while not a complete list, provides a great deal of benefit in the reduction of cancer risk. With 12 million cancer survivors in the United States, there is a need for a parallel set of recommendations that oncologists and primary care providers may routinely use for individuals following a cancer diagnosis focused on improving the quantity and quality of life after diagnosis. With increasing survival rates and many cancer survivors dying from noncancer causes, survivorship care necessarily focuses on more than just risk of cancer recurrence and cancer-related mortality. Methods To provide a foundation for living a healthy life after a cancer diagnosis, we developed a set of evidence-based health messages for cancer survivors. “Cancer Survivors’ Eight Ways to Stay Healthy After Cancer,” published by the Siteman Cancer Center at Washington University School of Medicine and Barnes Jewish Hospital, documents both the evidence supporting the recommendations as well as tips for implementing them. Results The one-line summary messages are: (1) don’t smoke, (2) avoid secondhand smoke, (3) exercise regularly, (4) avoid weight gain, (5) eat a healthy diet, (6) drink alcohol in moderation, if at all, (7) stay connected with friends, family, and other survivors, (8) get screening tests and go to your regular checkups. Conclusions The cancer survivors’ eight ways are the foundation for an evidence-based health promotion program for survivors.

Breast cancer is the most common invasive cancer among women in developed countries. Obesity is a major risk factor for breast cancer recurrence and mortality in both pre-and postmenopausal women. Co-morbid medical conditions are common among breast cancer survivors. The Exercise and Nutrition to Enhance Recovery and Good Health for You (ENERGY) study is a 4-year randomized clinical trial of 693 overweight/obese women aged ≥21 years diagnosed with any early stage breast cancer (stages I[≥1 cm]-III) within the previous five years, designed to demonstrate the feasibility of achieving sustained weight loss and to examine the impact of weight loss on quality of life and co-morbidities, and to enable future exploration of biochemical mechanisms linking obesity to lower likelihood of disease-free survival. This trial is strategically designed as a vanguard for a fully-powered trial of women who will be evaluated for breast cancer recurrence and disease-free survival. Participants were recruited between 2010 and 2012 at four sites, had completed initial therapies, and had a body mass index between 25 and 45 kg/m2. The intervention featured a group-based cognitive-behavioral weight loss program with telephone counseling and tailored newsletters to support initial weight loss and subsequent maintenance, with the goal of 7% weight loss at two years. This study has high potential to have a major impact on clinical management and outcomes after a breast cancer diagnosis. This trial initiates the effort to establish weight loss support for overweight or obese breast cancer survivors as a new standard of clinical care.

Physical activity can enhance quality of life in cancer survivors, but this conclusion is based largely on research linking moderate-to-vigorous physical activity with quality of life. Light-intensity physical activity may be more feasible than more strenuous exercise for many older cancer survivors. This study reports a secondary analysis of baseline data from a lifestyle behavior intervention trial and examines the hypothesis that older cancer survivors who engage in more light-intensity physical activity, independent of moderate-to-vigorous activity, will report better mental quality of life. Older (≥65 years), overweight or obese breast, prostate, or colorectal cancer survivors (n = 641, 54% female) self-reported their physical activity and mental quality of life (i.e., mental health, emotional role functioning, vitality, and social role functioning from the Short-Form 36 Health Status Survey) as a part of the RENEW trial baseline assessment. Analysis of covariance was used to test hypotheses. For older women (but not men), light physical activity was positively associated with mental quality of life after adjusting for moderate-to-vigorous physical activity. Light physical activity that involved social participation appeared to be responsible for this association. For older men (but not women), moderate-to-vigorous physical activity was positively associated with mental quality of life. Some activity appears to be better than none for important dimensions of mental quality of life. Experimental research is needed to test the hypothesis that older cancer survivors should strive to avoid inactivity regardless of whether they are able to engage in moderate-to-vigorous physical activity.

PurposeComorbid medical conditions are common among breast cancer survivors, contribute to poorer long-term survival and increased overall mortality, and may be ameliorated by weight loss. This secondary analysis evaluated the impact of a weight loss intervention on comorbid medical conditions immediately following an intervention (12months) and 1-year postintervention (24months) using data from the Exercise and Nutrition to Enhance Recovery and Good health for You (ENERGY) trial-a phase III trial which was aimed at and successfully promoted weight loss.MethodsENERGY randomized 692 overweight/obese women who had completed treatment for early stage breast cancer to either a 1-year group-based behavioral intervention designed to achieve and maintain weight loss or to a less intensive control intervention. Minimal support was provided postintervention. New medical conditions, medical conditions in which non-cancer medications were prescribed, hospitalizations, and emergency room visits, were compared at baseline, year 1, and year 2. Changes over time were analyzed using chi-squared tests, Kaplan-Meier, and logistic regression analyses.ResultsAt 12months, women randomized to the intervention had fewer new medical conditions compared to the control group (19.6 vs. 32.2%, p&nbsp

Despite convincing evidence that physical activity protects against colon and breast cancers, the association of physical activity with urologic cancers is less well explored. Expert panels have previously found a probably protective benefit for prostate cancer, but insufficient evidence for other urologic cancers. We review the evidence for testicular, kidney/renal, bladder, and prostate cancers, including whether benefits may exist within subgroups. While the limited evidence base does not support an association of physical activity with either testicular or bladder cancers, a growing body of research suggests that physical activity results in a modest risk reduction for kidney cancer. A large number (>30) of studies suggests a probable small decrease in prostate cancer risk among those who are physically active, which is likely driven by the effect on advanced/aggressive tumors. The role of physical activity in decreasing urologic cancer risk is thus likely limited to advanced prostate and possibly kidney cancers with no association in testicular or bladder cancers.

Objectives To examine whether agreement between self-reported and accelerometer measured physical activity varies by BMI category in a low-income black sample.

Intervention trials in cancer survivors play an important and growing role in complementing the wealth of knowledge obtained from observational studies about how lifestyle can improve clinical, physiologic, and psychological outcomes. As the number of intervention trials grows, attention to study design and reporting is essential to establishing a high-quality data pool from which to make evidence-based recommendations and guidelines. We highlight several key issues important to the design and interpretation of intervention trials in cancer survivors. Intervention dose and duration both matter in trials of cancer survivors, yet few trials have evaluated different intervention doses and few intervention trials with multiyear follow-up exist. Finally, there is a need for interventions both of longer duration and those that take a practical trials approach and reflect clinical practice to speed implementation within practice and improve outcomes for cancer survivors. Cancer Epidemiol Biomarkers Prev; 20(10); 2078–84. ©2011 AACR.

Learning Objectives After completing this course, the reader will be able to: Outline a process that cancer organizations can use to design, implement, prioritize, and evaluate cancer survivor programs.Describe the scientific evidence for benefit from survivorship interventions and the process and strategies for implementation and evaluation to promote sustainable programs. This article is available for continuing medical education credit at CME.TheOncologist.com Although calls for improvements in cancer survivorship planning and programming exist, implementation has lagged. As with most guidelines, moving from recommendations to implementation requires active planning and systems changes to insure sustained use. Here, we draw on the latest in implementation science to outline a process that cancer organizations can use in designing, implementing, prioritizing, and evaluating cancer survivor programs to improve patient outcomes, using smoking cessation as a primary example. We consider the scientific evidence for benefit from interventions and the strategy for implementation and evaluation to sustain programs.

BACKGROUND: Little evidence is available on the relation of physical activity with colon adenomas, a colon cancer precursor. METHODS: We conducted a systematic literature review and meta-analysis of published studies (in English) through April 2010, examining physical activity or exercise and risk or prevalence of colon adenoma or polyp. Random effects models were used to estimate relative risks (RRs) and corresponding confidence intervals (CIs). A total of 20 studies were identified that examined the association and provided RRs and corresponding 95% CIs. RESULTS: A significant inverse association between physical activity and colon adenomas was found with an overall RR of 0.84 (CI: 0.77–0.92). The association was similar in men (RR ¼0.81, CI: 0.67–0.98) and women (RR ¼0.87, CI: 0.74–1.02). The association appeared slightly stronger in large/advanced polyps (RR ¼0.70, CI: 0.56–0.88). CONCLUSION: This study confirms previous reports of a significant inverse association of physical activity and colon adenoma, and suggests that physical activity can have an important role in colon cancer prevention.

Early detection and improved treatments for cancer have resulted in roughly 12 million survivors alive in the United States today. This growing population faces unique challenges from their disease and treatments, including risk for recurrent cancer, other chronic diseases, and persistent adverse effects on physical functioning and quality of life. Historically, clinicians advised cancer patients to rest and to avoid activity; however, emerging research on exercise has challenged this recommendation. To this end, a roundtable was convened by American College of Sports Medicine to distill the literature on the safety and efficacy of exercise training during and after adjuvant cancer therapy and to provide guidelines. The roundtable concluded that exercise training is safe during and after cancer treatments and results in improvements in physical functioning, quality of life, and cancer-related fatigue in several cancer survivor groups. Implications for disease outcomes and survival are still unknown. Nevertheless, the benefits to physical functioning and quality of life are sufficient for the recommendation that cancer survivors follow the 2008 Physical Activity Guidelines for Americans, with specific exercise programming adaptations based on disease and treatment-related adverse effects. The advice to "avoid inactivity," even in cancer patients with existing disease or undergoing difficult treatments, is likely helpful. 4.106 JCR (2010) Q1, 3/80 Sport sciences UEM

Urinary incontinence is one of the most commonly reported and distressing side effects of radical prostatectomy for prostate carcinoma. Several studies have suggested that symptoms may be worse in obese men but to our knowledge no research has addressed the joint effects of obesity and a sedentary lifestyle. We evaluated the association of obesity and lack of physical activity with urinary incontinence in a sample of men who had undergone radical prostatectomy.Height and weight were abstracted from charts, and obesity was defined as body mass index 30 kg/m(2) or greater. Men completed a questionnaire before surgery that included self-report of vigorous physical activity. Men who reported 1 hour or more per week of vigorous activities were considered physically active. Men reported their incontinence to the surgeon at their urology visits. Information on incontinence was abstracted from charts at 6 and 58 weeks after surgery.At 6 weeks after surgery 59% (405) of men were incontinent, defined as any pad use. At 58 weeks after surgery 22% (165) of men were incontinent. At 58 weeks incontinence was more prevalent in men who were obese and physically inactive (59% incontinent). Physical activity may offset some of the negative consequences of being obese because the prevalence of incontinence at 58 weeks was similar in the obese and active (25% incontinent), and nonbese and inactive (24% incontinent) men. The best outcomes were in men who were nonobese and physically active (16% incontinent). Men who were not obese and were active were 26% less likely to be incontinent than men who were obese and inactive (RR 0.74, 95% CI 0.52-1.06).Pre-prostatectomy physical activity and obesity may be important factors in post-prostatectomy continence levels. Interventions aimed at increasing physical activity and decreasing weight in patients with prostate cancer may improve quality of life by offsetting the negative side effects of treatment.

Purpose: To examine whether knowledge of the 1995 Centers for Disease Control and Prevention (CDC) and the American College of Sports Medicine (ACSM) national physical activity recommendations varies by sociodemographic, behavioral, and communication-related factors. Methods: Cross-sectional analyses of 2381 participants in the 2005 Health Information National Trends Survey, a national probability sample of the US population contacted via random-digit dial. Results: Only a third of respondents were accurately knowledgeable of the CDC/ACSM physical activity recommendations. Recommendation knowledge was higher among women (OR = 1.70; 95% confidence interval (CI) = 1.35-2.14) than men, the employed compared with those not currently working (OR = 0.73; 95% CI = 0.55-0.95), foreign-born individuals (OR = 1.62; 95% CI = 1.15-2.30) compared with the US-born, and those meeting CDC/ACSM recommendations vs those who do not (OR = 0.74; 95% CI = 0.58-0.96). Conclusions: There is not widespread knowledge of the consensus national physical activity recommendations. These findings highlight the need for more effective campaigns to promote physical activity among the American public

We review and update evidence on obesity, weight gain and weight loss in relation to leading cancers since the International Agency for Research on Cancer report of 2002. Emphasis is placed on the time course of disease and implications for weight control to prevent cancer. We conclude that weight loss could prevent a major portion of common cancers.

Blacks experience disproportionately elevated rates of tobacco-related morbidity and mortality. Blacks experience delayed smoking initiation relative to other racial/ethnic groups, highlighting the importance of examining smoking correlates occurring in late adolescence/early adulthood. The current study reports data collected as part of an ongoing collaborative effort to assess alcohol and drug use on the campuses of historically black colleges and universities (HBCUs). Two-thousand, two-hundred, seventy-seven African-American subjects, aged 20.3 ± 3.9 (range 18-53), completed the CORE Alcohol and Drug survey and a brief demographic questionnaire. Results indicated that 90% of all subjects overestimated the rate of smoking among their peers. Overestimating was associated with a > 80% increase in the risk of smoking. These data highlight the need to correct misinformation regarding smoking norms among students at some HBCUs.

Background:The interrelations between various physical activity domains have received little empirical attention in the United States. Of particular interest, given the potential applicability to traditionally underserved communities, is the nature of the association between occupational physical activity (OPA) and leisure-time physical activity (LTPA).Methods:5448 adult men and women who participated in NHANES 1999–2000 were included in analyses. Linear regression was used to examine the bivariate and multivariable associations of OPA and education with LTPA. Generalized logit models were used to examine the association of education with OPA.Results:We found no association between education and LTPA. OPA was significantly positively associated with LTPA (P < .001). The association between OPA and LTPA was not strongest among those with low education and held only for men in gender-stratified analysis. Education was inversely associated with OPA (P < .001) in multivariable analysis.Conclusions:Our findings lend preliminary support to the hypothesis that OPA is an important determinant of LTPA, particularly in men. This provides additional support to calls for assessment of OPA, particularly among individuals of low social class.

The prevalence of both obesity and prostate cancer are increasing in the US. Recently, there has been keen interest in the relationship between obesity and the biology of cancers, including prostate cancer. This article reviews the current literature regarding body mass index (BMI) and its relationship with various clinical aspects of prostate cancer, including its incidence, screening, diagnosis and treatment. Despite several biological mechanisms that potentially link obesity to prostate cancer, the effects of obesity on serum PSA levels and prostate volume, and the subsequent effects on the detection of prostate cancer, are not consistent according to the available literature. Additionally, the epidemiologic data for the incidence of prostate cancer in obese and non-obese populations are conflicting. Treatment of prostate cancer in obese populations is problematic, but data on the ability to overcome these difficulties are unclear. It is difficult to determine whether oncologic and functional outcomes in obese patients differ substantially from those in non-obese patients. Separating the contributions of technical issues from potentially different tumor biologies is not currently possible. Hopefully, the increasing focus on these two highly prevalent health problems might further elucidate their complex relationship.

Background Despite its health benefits, physical inactivity is pervasive, particularly among those living in lower-income urban communities. In such settings, neighborhood safety may impact willingness to be regularly physically active. We examined the association of perceived neighborhood safety with pedometer-determined physical activity and physical activity self-efficacy. Methods and Findings Participants were 1,180 predominantly racial/ethnic minority adults recruited from 12 urban low-income housing complexes in metropolitan Boston. Participants completed a 5-d pedometer data-collection protocol and self-reported their perceptions of neighborhood safety and self-efficacy (i.e., confidence in the ability to be physically active). Gender-stratified bivariate and multivariable random effects models were estimated to account for within-site clustering. Most participants reported feeling safe during the day, while just over one-third (36%) felt safe at night. We found no association between daytime safety reports and physical activity among both men and women. There was also no association between night-time safety reports and physical activity among men (p = 0.23) but women who reported feeling unsafe (versus safe) at night showed significantly fewer steps per day (4,302 versus 5,178, p = 0.01). Perceiving one's neighborhood as unsafe during the day was associated with significantly lower odds of having high physical activity self-efficacy among both men (OR 0.40, p = 0.01) and women (OR 0.68, p = 0.02). Conclusions Residing in a neighborhood that is perceived to be unsafe at night is a barrier to regular physical activity among individuals, especially women, living in urban low-income housing. Feeling unsafe may also diminish confidence in the ability to be more physically active. Both of these factors may limit the effectiveness of physical activity promotion strategies delivered in similar settings., Garry Bennett and colleagues measured exercise levels and obtained opinions on neighborhood safety. They concluded that residing in a neighborhood perceived to be unsafe at night is a barrier to regular physical activity., Editors' Summary Background. Nowadays we are all encouraged to do more physical activity, as it has been shown that inactivity increases the risk of many medical conditions, including obesity, heart attacks, and strokes. Inactive people die younger. Previous research has shown that people on a low income and those from ethnic or racial minorities have the lowest activity levels. There are, however, many barriers to being active. It has been claimed that people who live in neighborhoods that are unsafe face particular difficulties. They might want to walk, cycle, or take other forms of outdoor exercise near their home, but they fear they would be injured as a result of a violent attack. It is usually the poorest members of society who live in unsafe areas. It is also known that those poor people who belong to minority racial or ethnic groups are particularly likely to feel unsafe. Why Was This Study Done? The researchers who did this study wanted to find out whether people in a low-income urban area in the US considered themselves to be unsafe in their neighborhood, and how much physical activity they took part in. Their aim was to establish whether there was an association between the perceived safety level and the amount of activity taken, or if the two were unrelated. Other researchers have tried to look for such an association before, but they have usually relied on how much activity people say they remember taking, not on the actual measured amount. The results from such research have been very varied and inconclusive. What Did the Researchers Do and Find? Working in one low-income district of one US city (Boston), they found over 1,000 people to participate in their study, most of whom were from ethnic minorities. They asked them the question: “How safe do you feel walking alone in your neighborhood?” Response options included “safe,” “a little unsafe,” and “unsafe.” The same question was asked about walking alone in the daylight and walking alone after dark. The people in the study also agreed to wear a pedometer for five days. This instrument measures the number of steps that the wearer takes. It is thus a much more accurate way of finding out about activity levels than asking people how much activity they think they have engaged in. Four out of five people said they did feel safe during the day, but there was no association between daytime safety and physical activity. This was the case for both men and women. Two-thirds of the people in the study felt unsafe in the night-time. There was no association between perceived night-time safety and physical activity among men, but women who reported feeling unsafe at night took around 1,000 fewer steps per day than other women. That amounts to around 20% less physical activity. What Do These Findings Mean? Even the women who felt safe at night were only taking around 5,000 steps per day, around half of what the US Surgeon General recommends for good health. So all the women in the study would benefit from more physical activity. However, the much lower amount of activity of the women who felt unsafe does suggest that a perceived lack of safety is an important factor, which could increase the risks to their health. It is interesting that the association between perceived safety and activity was not found in men and only applied to night-time safety. However, the authors argue that their findings provide preliminary evidence that perceived low neighborhood safety may serve as a barrier to physical activity in low-income areas. They discuss in the article the need for further research. Additional Information. Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.0040306. • The UK National Health Service publishes the online NHS Direct Health Encyclopedia, which describes the benefits of exercise and gives recommendations • Information on exercise may also be found on MedlinePlus, a service of the US National Library of Medicine and the National Institutes of Health

In a previous study of Hispanic women, we reported a positive association between sedentary time and percent breast density, a marker of breast cancer risk. It is unclear whether associations between sedentary time or physical activity and percent breast density are mediated through serum insulin levels or insulin resistance, factors also associated with physical activity and breast cancer risk.In the Chicago Breast Health Project phase II pilot study, detailed information on health and lifestyle factors, including sitting time and total physical activity over the previous 7 days, was collected from 95 Hispanic women aged 40-77 years. We also assessed percent breast density and measured fasting serum insulin and glucose to calculate the Homeostasis Model Assessment (HOMA) index, a measure of insulin resistance. Multivariable linear regression was used to assess associations of total physical activity, time spent sitting, serum insulin, and HOMA index with percent breast density.There was no association between total physical activity and percent breast density (p = 0.98), whereas there was a positive association between sedentary time and percent density (beta = 0.25% per 100 metabolic equivalent (MET)-minutes/week, p = 0.06). Percent breast density was not associated with insulin or with HOMA index. The strength of the association between time spent sitting and percent density was unchanged after inclusion of insulin or the HOMA index in the model.These results are consistent with our previous finding of an association between sedentary time and percent breast density and suggest that insulin or insulin resistance is unlikely to mediate this relation.

Background Despite studies showing that physically active individuals report higher quality-of-life scores, few data exist on the impact of changing physical activity levels on subsequent changes in quality of life. Methods Subjects were 63,152 women in the Nurses’ Health Study aged 40 to 67 years in 1986. Women reported their physical activity on questionnaires in 1986, 1988, 1992, 1994, and 1996, and were grouped according to quartile of change in activity from 1986 to 1996. Women also reported seven health-related quality-of-life dimensions in 1996 and 2000 using the Medical Outcomes Study Short-Form 36 Health Status Survey. The main outcome measures were scores for each of these seven dimensions in 1996, as well as changes in each of these dimensions from 1996 to 2000. Data were analyzed in 2006. Results In age and baseline activity adjusted analyses, compared to women whose physical activity was relatively stable from 1986 to 1996, women who saw any increase in physical activity levels had higher quality-of-life scores in 1996. Among women with a clear increase in physical activity, the increase in quality-of-life scores ranged from 2.23 (95% confidence intervals [CI]=1.94–2.52) for mental health to 8.23 (95% CI=7.49–8.97) for role limitations due to physical problems. Increasing physical activity also was associated with greater increases in quality-of-life scores from 1996 to 2000 compared to women whose physical activity level was stable. The strongest association was for role limitations due to physical problems, where women with a clear increase in physical activity had a significant improvement (1.81, 95% CI=1.09–2.53) in the outcome. Conclusions Long-term physical activity patterns are an important determinant of health-related quality of life.

Objective—The association between physical activity or cardiovascular fitness and chronic disease risk in men might be mediated, in part, through androgens. Limited data exists on the potential associations of activity or fitness with serum hormones. We examined the associations of serum testosterone and sex hormone binding globulin (SHBG) concentrations with physical activity and cardiorespiratory fitness in black and white young men. Method—Data were collected from 391 black and 604 white male participants of the Coronary Artery Risk Development in (Young) Adults (CARDIA) Male Hormone Study aged 24–32 in 1992– 1993. Cross-sectional associations of serum total testosterone (TT), bioavailable testosterone (BT) and SHBG levels with self-reported total physical activity score, and in a subset of men (n=617) with cardiorespiratory fitness measured via duration on a treadmill test were assessed. Five-year longitudinal associations of change in hormones with changes in physical activity also were examined. Results—There were no cross-sectional or longitudinal associations of physical activity with SHBG, TT or BT in either black or white men. Fitness was positively associated with SHBG only in white men, but was not associated with TT or BT in either group. Conclusion—Overall the results do not support an association of self-reported physical activity with androgens, whereas they do suggest that fitness might be associated with SHBG in white men.

Obesity is a poor prognostic factor and is negatively related to quality of life (QOL) in breast cancer survivors. Exercise and Nutrition to Enhance Recovery and Good Health for You is the largest weight loss trial completed among cancer survivors. Percent losses in body weight with an intensive group-based intervention versus an attention control were 6.0 versus 1.5% (p&nbsp

Purpose Obesity increases risk for all-cause and breast cancer mortality and comorbidities in women who have been diagnosed and treated for breast cancer. The Exercise and Nutrition to Enhance Recovery and Good Health for You (ENERGY) study is the largest weight loss intervention trial among survivors of breast cancer to date. Methods In this multicenter trial, 692 overweight/obese women who were, on average, 2 years since primary treatment for early-stage breast cancer were randomly assigned to either a group-based behavioral intervention, supplemented with telephone counseling and tailored newsletters, to support weight loss or a less intensive control intervention and observed for 2 years. Weight and blood pressure were measured at 6, 12, 18, and 24 months. Longitudinal mixed models were used to analyze change over time. Results At 12 months, mean weight loss was 6.0% of initial weight in the intervention group and 1.5% in the control group (P < .001). At 24 months, mean weight loss in the intervention and control groups was 3.7% and 1.3%, respectively (P < .001). Favorable effects of the intervention on physical activity and blood pressure were observed. The weight loss intervention was more effective among women older than 55 years than among younger women. Conclusion A behavioral weight loss intervention can lead to clinically meaningful weight loss in overweight/obese survivors of breast cancer. These findings support the need to conduct additional studies to test methods that support sustained weight loss and to examine the potential benefit of intentional weight loss on breast cancer recurrence and survival.

Current guidelines recommend weight loss in obese cancer survivors. Weight loss, however, has adverse effects on bone health in obese individuals without cancer but this has not been evaluated in breast cancer survivors. We investigated the associations of intentional weight loss with bone mineral density (BMD) and bone turn-over markers in overweight/obese postmenopausal breast cancer survivors. Participants were overweight/obese breast cancer survivors (N = 81) with stage I, II or IIIA disease enrolled in the St. Louis site of a multi-site Exercise and Nutrition to Enhance Recovery and Good health for You (ENERGY) study; a randomized-controlled clinical trial designed to achieve a sustained ≥7 % loss in body weight at 2 years. Weight loss was achieved through dietary modification with the addition of physical activity. Generalized estimating equations were used to assess differences in mean values between follow-up and baseline. Mean weight decreased by 3 and 2.3 % between baseline and 6-month follow-up, and 12-month follow-up, respectively. There were decreases in osteocalcin (10.6 %, p value < 0.001), PINP (14.5 %, p value < 0.001), NTx (19.2 % p value < 0.001), and RANK (48.5 %, p value < 0.001), but not BALP and CTX-1 levels between baseline and 12-month follow-up. No significant changes occurred in mean T-scores, pelvis and lumbar spine BMD between baseline and 12-month follow-up. A 2.3 % weight loss over 12 months among overweight/obese women with early-stage breast cancer does not appear to have deleterious effect on bone health, and might even have beneficial effect. These findings warrant confirmation, particularly among breast cancer survivors with a larger magnitude of weight loss.

Author(s): Breyer, Benjamin N; Huang, Wen-Yi; Rabkin, Charles S; Alderete, John F; Pakpahan, Ratna; Beason, Tracey S; Kenfield, Stacey A; Mabie, Jerome; Ragard, Lawrence; Wolin, Kathleen Y; Grubb, Robert L; Andriole, Gerald L; Sutcliffe, Siobhan | Abstract: ObjectiveTo examine whether a history of sexually transmitted infections (STIs) or positive STI serology is associated with prevalent and incident benign prostatic hyperplasia (BPH)/lower urinary tract symptoms (LUTS)-related outcomes in the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial.MethodsSelf-reported history of STIs (gonorrhoea, syphilis) was ascertained at baseline, and serological evidence of STIs (Chlamydia trachomatis, Trichomonas vaginalis, human papillomavirus (HPV)-16, HPV-18, herpes simplex virus type 2, human herpesvirus type 8 and cytomegalovirus) was detected in baseline serum specimens. We used data collected on the baseline questionnaire, as well as results from the baseline prostate-specific antigen (PSA) test and digital rectal examination (DRE), to define prevalent BPH/LUTS-related outcomes as evidence of LUTS (self-reported diagnosis of an enlarged prostate/BPH, BPH surgery or nocturia [waking ≥2 times/night to urinate]) and evidence of prostate enlargement (PSA g 1.4 ng/mL or prostate volume ≥30 mL) in men without prostate cancer. We created a similar definition of incident BPH using data from the follow-up questionnaire completed 5-13 years after enrolment (self-reported diagnosis of an enlarged prostate/BPH or nocturia), data on finasteride use during follow-up, and results from the follow-up PSA tests and DREs. We used Poisson regression with robust variance estimation to calculate prevalence ratios (PRs) in our cross-sectional analysis of self-reported (n = 32 900) and serologically detected STIs (n = 1 143) with prevalent BPH/LUTS, and risk ratios in our prospective analysis of self-reported STIs with incident BPH/LUTS (n = 5 226).ResultsGenerally null results were observed for associations of a self-reported history of STIs and positive STI serologies with prevalent and incident BPH/LUTS-related outcomes, with the possible exception of T. vaginalis infection. This STI was positively associated with prevalent nocturia (PR 1.36, 95% confidence interval (CI) 1.18-1.65), prevalent large prostate volume (PR 1.21 95% CI 1.02-1.43), and any prevalent BPH/LUTS (PR 1.32 95% CI 1.09-1.61); too few men had information on both STI serologies and incident BPH/LUTS to investigate the associations between T. vaginalis infection and incident BPH/LUTS-related outcomes.ConclusionsOur findings do not support associations of several known STIs with BPH/LUTS-related outcomes, although T. vaginalis infection may warrant further study.

Background While eHealth approaches hold promise for improving the reach and cost-effectiveness of behavior change interventions, they have been challenged by declining participant engagement over time, particularly for self-monitoring behaviors. These are significant concerns in the context of chronic disease prevention and management where durable effects are important for driving meaningful changes. Purpose “Be Fit, Be Well” was an eHealth weight loss intervention that allowed participants to self-select a self-monitoring modality (web or interactive voice response (IVR)). Participants could change their modality. As such, this study provides a unique opportunity to examine the effects of intervention modality choice and changing modalities on intervention engagement and outcomes. Methods Intervention participants, who were recruited from community health centers, (n = 180) were expected to self-monitor health behaviors weekly over the course of the 24-month intervention. We examined trends in intervention engagement by modality (web, IVR, or changed modality) among participants in the intervention arm. Results The majority (61%) of participants chose IVR self-monitoring, while 39% chose web. 56% of those who selected web monitoring changed to IVR during the study versus no change in those who initially selected IVR. Self-monitoring declined in both modalities, but completion rates were higher in those who selected IVR. There were no associations between self-monitoring modality and weight or blood pressure outcomes. Conclusions This is the first study to compare web and IVR self-monitoring in an eHealth intervention where participants could select and change their self-monitoring modality. IVR shows promise for achieving consistent engagement.

Objectives. We evaluated the association between television viewing and pedometer-determined physical activity among predominantly racial/ethnic minority residents of low-income housing in metropolitan Boston in 2005. Methods. We used mixed models to analyze the association between reported hours of television viewing and pedometer-determined steps per day among 486 adults. We also examined whether television viewing was associated with the achievement of 10 000 steps per day. Results. There was a mean 3.6 hours of average daily television watching. In multivariable analyses, each hour of television viewing on an average day was associated with 144 (95% confidence interval [CI] = ‐276, ‐12) fewer steps per day and a decreased likelihood of accumulating 10 000 steps per day (odds ratio [OR] = 0.84; 95% CI = 0.71, 0.99). Weekday and weekend television viewing were each also associated with fewer steps per day. Conclusions. Average daily television viewing was associated with reductions in total pedometer-determined physical activity levels (approximately 520 steps per day) in this lower-income sample. As part of a comprehensive physical activity promotion plan, recommendations to reduce television viewing should be made. (Am J Public Health. 2006;96:1681‐1685. doi:10.2105/AJPH.2005.080580)