PURPOSEThe number of cancer survivors worldwide is growing, with over 15.5 million cancer survivors in the United States alone—a figure expected to double in the coming decades. Cancer survivors face ...unique health challenges as a result of their cancer diagnosis and the impact of treatments on their physical and mental well-being. For example, cancer survivors often experience declines in physical functioning and quality of life while facing an increased risk of cancer recurrence and all-cause mortality compared with persons without cancer. The 2010 American College of Sports Medicine Roundtable was among the first reports to conclude that cancer survivors could safely engage in enough exercise training to improve physical fitness and restore physical functioning, enhance quality of life, and mitigate cancer-related fatigue.
METHODSA second Roundtable was convened in 2018 to advance exercise recommendations beyond public health guidelines and toward prescriptive programs specific to cancer type, treatments, and/or outcomes.
RESULTSOverall findings retained the conclusions that exercise training and testing were generally safe for cancer survivors and that every survivor should “avoid inactivity.” Enough evidence was available to conclude that specific doses of aerobic, combined aerobic plus resistance training, and/or resistance training could improve common cancer-related health outcomes, including anxiety, depressive symptoms, fatigue, physical functioning, and health-related quality of life. Implications for other outcomes, such as peripheral neuropathy and cognitive functioning, remain uncertain.
CONCLUSIONSThe proposed recommendations should serve as a guide for the fitness and health care professional working with cancer survivors. More research is needed to fill remaining gaps in knowledge to better serve cancer survivors, as well as fitness and health care professionals, to improve clinical practice.
Introduction Although decline in muscle mass and quality and resulting declines in muscle strength are associated with aging, more research is needed in general populations to assess the utility of ...handgrip strength as an indicator of muscle strength and cardiovascular disease risk. Methods Data from 4,221 participants aged ≥20 years in the 2011–2012 cycle of National Health and Nutrition Examination Survey were analyzed during 2014–2015. Standing isometric relative handgrip strength (calculated as maximal absolute handgrip strength from both hands divided by BMI) was used to predict cardiovascular biomarkers, including blood pressure (measured systolic and diastolic blood pressure); serum lipids (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides); and plasma insulin and glucose. Results Results from regression analyses showed that higher relative grip strength was significantly associated with lower systolic blood pressure, triglycerides, and plasma insulin and glucose, and higher high-density lipoprotein cholesterol in male and female participants ( p <0.05 for all). Secondary descriptive analyses found that absolute handgrip strength increased significantly with increasing weight status, but relative handgrip strength decreased significantly with increasing weight status. Conclusions Results suggest that increased relative handgrip strength may be associated with a better profile of cardiovascular health biomarkers among U.S. adults. Relative grip strength, which both adjusts for the confounding of mass and assesses concomitant health risks of increased body size and low muscle strength, may be a useful public health measure of muscle strength.
Objective: Given the critical role of behavior in preventing and treating chronic diseases, it is important to accelerate the development of behavioral treatments that can improve chronic disease ...prevention and outcomes. Findings from basic behavioral and social sciences research hold great promise for addressing behaviorally based clinical health problems, yet there is currently no established pathway for translating fundamental behavioral science discoveries into health-related treatments ready for Phase III efficacy testing. This article provides a systematic framework for developing behavioral treatments for preventing and treating chronic diseases. Method: The Obesity-Related Behavioral Intervention Trials (ORBIT) model for behavioral treatment development features a flexible and progressive process, prespecified clinically significant milestones for forward movement, and return to earlier stages for refinement and optimization. Results: This article presents the background and rationale for the ORBIT model, a summary of key questions for each phase, a selection of study designs and methodologies well-suited to answering these questions, and prespecified milestones for forward or backward movement across phases. Conclusions: The ORBIT model provides a progressive, clinically relevant approach to increasing the number of evidence-based behavioral treatments available to prevent and treat chronic diseases.
The National Cancer Institute developed the Family Life, Activity, Sun, Health, and Eating (FLASHE) Study to examine multiple cancer preventive behaviors within parent–adolescent dyads. The purpose ...of creating FLASHE was to enable the examination of physical activity, diet, and other cancer preventive behaviors and potential correlates among parent–adolescent dyads. FLASHE surveys were developed from a process involving literature reviews, scientific input from experts in the field, cognitive testing, and usability testing. This cross-sectional, web-based study of parents and their adolescent children (aged 12–17 years) was administered between April and October 2014. The nationwide sample consisted of 1,573 parent–adolescent dyads (1,699 parents and 1,581 adolescents) who returned all FLASHE surveys. FLASHE assessed parent and adolescent reports of several intrapersonal and interpersonal domains (including psychosocial variables, parenting, and the community and home environments). On a subset of example FLASHE items across these domains, responses of parents and adolescents within the same dyads were positively and significantly correlated ( r =0.32–0.63). Analyses were run in 2015–2016. FLASHE data present multiple opportunities for studying research questions among individuals or dyads, including the ability to examine similarity between parents and adolescents on many constructs relevant to cancer preventive behaviors. FLASHE data are publicly available for researchers and practitioners to help advance research on cancer preventive health behaviors.
Introduction This study describes the calibration and validity of the Youth Activity Profile (YAP) for use in the National Cancer Institute’s Family Life, Activity, Sun, Health, and Eating (FLASHE) ...study. The calibrated YAP was designed to estimate minutes of moderate to vigorous physical activity (MVPA) and sedentary behavior (SB). Methods The YAP was calibrated/validated in adolescents (aged 12–17 years) using cross-sectional data from the FLASHE study. Participants wore a GT3X+ ActiGraph on the dominant wrist for 7 days and then completed the YAP. Calibration was conducted for school ( n =118); out of school ( n =119); weekend ( n =61); and SB ( n =116) subsections of the YAP and by regressing percentage time in MVPA/SB (%MVPA/%SB) on each respective YAP subsection score, age, and the interaction between these two. The final algorithms were applied to independent samples ( n =39–51) to examine validity (median absolute percentage error, equivalence testing). Results The final algorithms explained 15% (school); 16% (out of school); and 12% (weekend) of the variability in GT3X+ %MVPA and 7% of the variability in GT3X+ %SB. The calibrated algorithms were applied to independent samples and predicted GT3X+ minutes of MVPA/SB, with median absolute percentage error values ranging from 12.5% (SB section) to 32.5% (weekend section). Predicted values obtained from the YAP were within 10%–20% of those produced by the GT3X+. Conclusions The YAP-predicted minutes of MVPA/SB resulted in similar group estimates obtained from an objective measure. The YAP offers good utility for large-scale research projects to characterize PA/SB levels among groups of youth.
IMPORTANCE: Monitoring sun protection and sunburn over time at the population level can provide valuable information about progress toward skin cancer prevention goals and inform future intervention ...efforts. OBJECTIVE: To examine the prevalence of sun protection use (shade, sunscreen, and clothing) and sunburn and the association between sunburn and individual characteristics and health behaviors in the US population. DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study using a nationally representative sample of 31 162 US adults from the 2015 National Health Interview Survey–Cancer Control Supplement, household interviews of civilian, noninstitutionalized US adults were conducted throughout 2015 in person and completed on the telephone when necessary. Data analysis was performed from August 16, 2016, to September 6, 2017. MAIN OUTCOMES AND MEASURES: The prevalence of sunburn and use of sun protection and their association with demographic characteristics, sun sensitivity, and health-related behaviors and conditions using multivariable logistic regression modeling. RESULTS: A total of 31 162 respondents (mean SD age, 47.0 0.36 years; 13 932 male 44.7% and 17 230 female 55.3%) were included in the analyses, with 34.2% experiencing sunburn in 2015. Sunburn prevalence was higher among younger age groups (51.2% in adults 18-29 years old; 95% CI, 48.8%-53.7%), non-Hispanic white individuals (42.5%; 95% CI, 41.2%-43.9%), and those with sun-sensitive skin (50.2%). However, sunburn was also prevalent among black (13.2%; 95% CI, 11.6%-15.1%) and Hispanic (29.7%; 95% CI, 27.6%-31.9%) individuals, demographic groups that are often considered to be at low risk of skin cancer. The most frequent sun protection behaviors were staying in the shade (37.1%; 95% CI, 36.3%-38.0%) and using sunscreen (31.5%; 95% CI, 30.7%-32.3%) followed by wearing long clothing to the ankles (28.4%; 95% CI, 27.6-29.1). Sun avoidance behaviors (seeking shade and not going in the sun) were significantly (39.5% vs 35.1%; P < .001) associated with a lower prevalence of sunburn. Those who used self-applied sunless tanning products (45.0% of users vs 36.1% of nonusers; P < .001), those who engaged in aerobic activity (37.9% of aerobic exercisers vs 32.8% of non–aerobic exercisers; P < .001), binge drinkers (45.1% of binge drinkers vs 35.0% of non–binge drinkers; P < .001), and overweight or obese individuals (37.9% of overweight or obese individuals vs 34.4% of non–overweight or obese individuals; P < .001) were more likely to experience sunburn compared with the respective comparison groups. CONCLUSIONS AND RELEVANCE: Sun sensitivity was significantly associated with a higher sunburn prevalence, independent of race/ethnicity, suggesting a need to consider sun sensitivity when identifying target demographic groups for sun safety interventions. Efforts to improve vigilance and consistency with use of sun protection are needed. In addition, those who engage in physical activity, use sunless tanners, or use sunscreen for tanning purposes may require additional intervention strategies to address the unique barriers they face in staying adequately protected.
The objective of this study is to update evidence‐based best practice guidelines for psychological evaluation and treatment of weight loss surgery (WLS) patients. We performed a systematic search of ...English‐language literature on WLS and mental health, quality of life, and behavior modification published between April 2004 and May 2007 in MEDLINE and the Cochrane Library. Key words were used to narrow the search for a selective review of s, retrieval of full articles, and grading of evidence according to systems used in established evidence‐based models. Our literature search identified 17 articles of interest; 13 of the most relevant were reviewed in detail. From these, we developed evidence‐based best practice recommendations on the psychological assessment and treatment of WLS patients. Regular updates of evidence‐based recommendations for best practices in psychological care are required to address the impact of mental health on short‐ and long‐term outcomes after WLS. Key factors in patient safety include comprehensive preoperative evaluation, use of appropriate and reliable evaluation instruments, and the development of short‐ and long‐term treatment plans.
IMPORTANCE: Understanding patterns of sun-protective behaviors and their association with sunburn can provide important insight into measurement approaches and intervention targets. OBJECTIVE: To ...assess whether decision-based modeling can be used to identify patterns of sun-protective behaviors associated with the likelihood of sunburn and to compare the predictive value of this method with traditional (ie, composite score) measurement approaches. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used a nationally representative sample of 31 162 US adults from the 2015 National Health Interview Survey, consisting of household interviews conducted in person and completed by telephone when necessary. Participants included civilian noninstitutionalized US adults. Data were collected from January 1 through December 31, 2015. MAIN OUTCOMES AND MEASURES: The associations among sun sensitivity, multiple sun-protective behaviors (ie, using sunscreen, seeking shade, wearing a hat, and wearing protective clothing), and sunburn were examined using a χ2 automatic interaction detection method for decision tree analysis. Results were compared with a composite score approach. RESULTS: In our study population of 28 558 respondents with complete data (54.1% women; mean SD age, 49.0 18.0 years), 20 patterns of sun protection were identified. Among 15 992 sun-sensitive individuals, those who used only sunscreen had the highest likelihood of sunburn (62.4%). The group with the lowest likelihood of sunburn did not report using sunscreen but engaged in the other 3 protective behaviors (24.3% likelihood of sunburn). Among 12 566 non–sun-sensitive individuals, those who engaged in all 4 protective behaviors had the lowest likelihood of sunburn (6.6%). The highest likelihood of sunburn was among those who only reported sunscreen use (26.2%). The decision tree model and the composite score approach correctly classified a similar number of cases; however, the decision tree model was superior in classifying cases with sunburn (44.3% correctly classified in the decision tree vs 25.9% with the composite score). CONCLUSIONS AND RELEVANCE: This innovative application of a decision tree analytic approach demonstrates the interactive and sometimes counterintuitive effects of multiple sun-protective behaviors on likelihood of sunburn. These data show where traditional measurement approaches of behavior may fall short and highlight the importance of linking behavior to a clinically relevant outcome. Given the scope of those affected and enormous associated health care costs, improving efforts in skin cancer prevention has the potential for a significant effect on public health.
This study examined the association between state physical education time requirements and physical activity and physical education outcomes among high school students.
State physical education time ...requirement laws for 2004–2016 from the Classification of Laws Associated with School Students database were linked with 2005–2017 national Youth Risk Behavior Survey data using state and year identifiers. Analyses were conducted between 2018 and 2019 to assess associations between physical education time requirement laws and physical activity or physical education outcomes using multinomial logistic regressions, while controlling for sociodemographic characteristics, year-fixed effects, and state confounders.
State laws requiring ≥90 minutes of physical education per week were associated with 3.1 percentage points lower probability of no days of physical activity ≥60 minutes (95% CI= −5.0, −1.1), 3.7 percentage points lower probability of no days of moderate exercise ≥30 minutes (95% CI= −6.2, −1.3), 4.2 percentage points lower probability of no days of vigorous exercise ≥20 minutes (95% CI= −5.2, −3.3), and 19.3 percentage points lower probability of not attending physical education class (95% CI= −34.4, −4.2). The laws were associated with a 2.4 percentage point higher probability of daily moderate exercise ≥30 minutes in male students (95% CI=0.6, 4.2) and a 3.4 percentage point higher probability in female students (95% CI=1.9, 4.9), with larger associations for female students (p<0.01).
Findings from this study help support the role that physical education state requirements can play in enhancing adolescents’ ability to meet recommended amounts of daily physical activity and the related public health benefits.
ABSTRACT
BACKGROUND
State recess laws are recommended to encourage adequate and equitable access to recess and its benefits, but the downstream effects of state recess laws are unknown. We examined ...the association of state recess laws with district‐level policy and school recess provision.
METHODS
This is cross‐sectional analysis of the School Health Policies and Practices Survey, a US nationally representative sample of school districts (2016) and schools (2014). State‐level recess laws were coded as none, recommend, or require recess. Logistic and linear regression were used to examine the association between state law with district policies and school recess provision, respectively. Data from 2000 are presented to highlight changes in recess policy and provision over time.
RESULTS
The odds of a district policy requiring recess were 2.22 and 2.34 times greater when state recess law recommended or required recess, respectively, compared to states with no recess policy. There were no significant differences in school‐level recess provision by state recess law but point estimates from 2000 indicated states without a law had the largest declines in recess provision over time.
CONCLUSIONS
State recess laws are positively associated with district‐level policy. Effects at the school level are unclear and continued surveillance is needed.
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