TY - JOUR
T1 - Breast Cancer Survivors’ Diet and Physical Activity Preferences and Barriers
T2 - How COVID-19 Changed the Intervention Landscape
AU - Chen, Xin
AU - Chiu, Chungyi
AU - Cheung, Helen Hoi Ting
AU - Crowder, Sylvia L.
AU - Chen, Xi
AU - Trinh, Linda
AU - Arthur, Anna E.
N1 - This study was supported by the University of Illinois at Urbana-Champaign (UIUC) Center for Social and Behavioral Sciences Seed Grant and the National Institute of Food and Agriculture of the United States Department of Agriculture (USDA-NIFA) Hatch Project 1011487.
In accordance with the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) guidelines, following a balanced and healthy diet (for example, avoiding processed meat) and engaging regular exercise at a moderate intensity benefit not only healthy individuals because of its effects in disease prevention [10], but also BCS for their effects in the preservation and improvement of psychosocial and cardiopulmonary functioning, HRQoL, and long-term survivorship [11\u201313]. However, there are still concerns, including BCS\u2019 failure to meet the recommendations for dietary intake and exercise, their special care needs, and the lack of strategies to design, operate, and carry out an optimal intervention [14,15]. Many BCS generally have poor diets and experience significant weight gain after diagnosis [16]. Being overweight and obese increase the risks of BC development and death after BC diagnosis [17,18]. Current findings strongly suggest exercise interventions targeting BCS have desirable outcomes such as improved weight maintenance, cardiopulmonary functioning, muscle strength and HRQoL, reduced fatigue, and psychological benefits [11,12,19]. Despite some mixed results, there is encouraging evidence supporting the efficacy of dietary interventions on achieving a healthy weight besides other health outcomes such as improved relapse-free survival and reduced self-reported functional decline in BCS [20\u201322]. Thus, exercise interventions that incorporate nutrition support may be of further benefit in reducing fat mass, increasing lean mass, and improved survivorship [23,24]. A 15-y follow-up study found that BCS initially improved their adherence to healthy behaviors post-diagnosis, but long-term maintenance was poor, particularly in physical activity and intake of fruits vegetables and nutrients [25]. A recent meta-analysis of 13 studies found that long-term survivors (>5 y) had lower adherence to WCRF/AICR health behavior recommendations [31%, 95% confidence interval (CI): 27%, 35%] compared with recent survivors (\u22645 y) at 25% (95% CI: 14%, 36%) [26]. To achieve significant long-term health benefits, it is vital that these healthy lifestyle behaviors are maintained over time. Therefore, more strategies are needed to develop optimal combined exercise and diet interventions, besides individual diet or exercise intervention, that integrate BCS\u2019 unique interests, comforts, preferences, and barriers to increase their participation and long-term adherence.By separating the data before and after the start of COVID-19 pandemic and performing analyses of the data from pre-C and during-C separately, we were able to compare the COVID-related changes in BCS\u2019 interests in, preferences for, barriers to diet and exercise intervention. Compared to pre-C, participants seemed to be more likely to take part in a research study testing the benefit of diet and exercise interventions, but less inclined to participate in in-person services or individual nutrition education/counseling. This observation was reinforced by the smaller proportion of participants who reported preferences for in-person diet and exercise resources (for example, information and counseling) and the smaller proportion who reported preferences for nutrition one-on-one education/counseling sessions during-C. In addition, a larger proportion of participants preferred distance-based methods or using visual communication tools (for example, Skype or FaceTime) to meet with the health specialists or to receive nutrition and exercise information during this period. For nutrition education/counseling, a group remote option may be appealing to BCS during-C. Overall, the results indicated reduced comfort level with in-person healthcare contacts and increased preferences for home-based diet and exercise intervention programs using technology and visual communication tools. Recent studies have provided preliminary evidence that web-based and computer-tailored interventions are promising to increase BCS exercise [38,39], indicating a great potential for technology-delivered cancer support services and care post-COVID-19.This study was supported by the University of Illinois at Urbana-Champaign (UIUC) Center for Social and Behavioral Sciences Seed Grant and the National Institute of Food and Agriculture of the United States Department of Agriculture (USDA-NIFA) Hatch Project 1011487.
PY - 2025/1
Y1 - 2025/1
N2 - Background: Existing studies on breast cancer survivors (BCS) have primarily focused on individual aspects of either diet or exercise preferences and barriers. Our study aims to examine BCS’ perceptions toward diet and exercise combined. Given the transformative impact of COVID-19, there is a crucial need for insights in the post-pandemic era to address the distinct challenges faced by BCS in maintaining their health and well-being. Objectives: This exploratory study aims to understand BCS’ preferences for and barriers to diet and exercise to inform future intervention development. Methods: A cross-sectional survey was administered to adults diagnosed with ductal carcinoma in situ or stage I–IV breast cancer (BC) from 2019 to 2021 regarding interest, preferences, and barriers to participating in diet and exercise interventions. Descriptive analysis compared pre-COVID-19 (pre-C) and during-COVID-19 pandemic (during-C) subsets. Results: There were 224 participants. Over half expressed interest in a BC research study related to diet and exercise. Most preferred receiving consultations in-person with relevant specialists, education or counseling in one-on-one sections, and information from written materials, in-person, or via technology. Barriers were fatigue, family, and work. One hundred and thirty participants completed the survey pre-C, and 94 during-C. Compared with pre-C, during-C participants preferred visual communication tools for information on nutrition and exercise over in-person methods (P < 0.05). In most categories, the percentage of barriers noted during-C was greater than pre-C. Conclusions: Participants indicated preference for dual-modal diet and exercise interventions. The pandemic impacted participation preferences and barriers, with shifts toward favoring visual communication tools over in-person services and increasing psychosocial and COVID-related barriers. Hybrid care, combining in-person with technology-based delivery, shows promise in enhancing flexibility and accessibility in nutrition and exercise interventions amid the pandemic.
AB - Background: Existing studies on breast cancer survivors (BCS) have primarily focused on individual aspects of either diet or exercise preferences and barriers. Our study aims to examine BCS’ perceptions toward diet and exercise combined. Given the transformative impact of COVID-19, there is a crucial need for insights in the post-pandemic era to address the distinct challenges faced by BCS in maintaining their health and well-being. Objectives: This exploratory study aims to understand BCS’ preferences for and barriers to diet and exercise to inform future intervention development. Methods: A cross-sectional survey was administered to adults diagnosed with ductal carcinoma in situ or stage I–IV breast cancer (BC) from 2019 to 2021 regarding interest, preferences, and barriers to participating in diet and exercise interventions. Descriptive analysis compared pre-COVID-19 (pre-C) and during-COVID-19 pandemic (during-C) subsets. Results: There were 224 participants. Over half expressed interest in a BC research study related to diet and exercise. Most preferred receiving consultations in-person with relevant specialists, education or counseling in one-on-one sections, and information from written materials, in-person, or via technology. Barriers were fatigue, family, and work. One hundred and thirty participants completed the survey pre-C, and 94 during-C. Compared with pre-C, during-C participants preferred visual communication tools for information on nutrition and exercise over in-person methods (P < 0.05). In most categories, the percentage of barriers noted during-C was greater than pre-C. Conclusions: Participants indicated preference for dual-modal diet and exercise interventions. The pandemic impacted participation preferences and barriers, with shifts toward favoring visual communication tools over in-person services and increasing psychosocial and COVID-related barriers. Hybrid care, combining in-person with technology-based delivery, shows promise in enhancing flexibility and accessibility in nutrition and exercise interventions amid the pandemic.
KW - COVID
KW - barriers
KW - breast cancer
KW - diet
KW - exercise
KW - lifestyle intervention
KW - preferences
KW - strategies
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U2 - 10.1016/j.cdnut.2024.104519
DO - 10.1016/j.cdnut.2024.104519
M3 - Article
AN - SCOPUS:85213576249
SN - 2475-2991
VL - 9
JO - Current Developments in Nutrition
JF - Current Developments in Nutrition
IS - 1
M1 - 104519
ER -