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Objectives: To assess the feasibility, acceptability, and preliminary effectiveness of implementing a home-based aerobic and resistance exercise for patients with breast cancer receiving endocrine treatment in Indonesia. Methods: This is a mixed methods study with concurrent design consisting of quantitative single-arm pre-post intervention and qualitative study. We recruited patients with breast cancer ( N = 36) receiving endocrine treatment and assigned 12 weeks of home-based pedometer-driven walking and resistance exercises using therapeutic bands. Descriptive statistics were used to assess the feasibility (recruitment, retention, and adherence) and safety. The modified Bruce treadmill test was used to measure predicted aerobic capacity ( V̇O 2 peak). Quality of life and fatigue were assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and fatigue severity scale. Measurements were performed at baseline and post-intervention and analyzed with the paired t -test or Wilcoxon test. Semi-structured interviews and thematic analysis were conducted post-intervention to explore patients’ acceptability. Results: The results showed a recruitment rate of 75%, retention rate of 89%, and adherence rates were 53% for aerobic and 78% for resistance exercise. No severe adverse events were reported. Post-intervention interviews identified positive attitudes toward the intervention, with low burden and high perceived benefit. Exercise duration and predicted V̇ O 2 peak increased significantly (+1.1 min, p = 0.001 and +2.3 ml/kg/min, p = 0.043), but no significant change was detected for Quality of Life ( p > 0.050) or fatigue severity ( p = 0.299). Conclusions: A home-based aerobic and resistance exercise was feasible when implemented in the context of routine care in our study population, improving predicted aerobic capacity. Further research is required to understand limited changes to Quality of Life and fatigue and adaptations to support implementation in additional sites in Indonesia.

BackgroundThe Canadian 24-Hour Movement Guidelines for adults provide specific recommendations for levels of physical activity, sedentary behavior, and sleep (ie, the movement behaviors) required for optimal health. Performance of the movement behaviors is associated with improved mental well-being. However, most postsecondary students do not meet the movement behavior recommendations within the Canadian 24-Hour Movement Guidelines and experience increased stress and declining well-being, suggesting the need for an intervention targeting students’ movement behaviors. ObjectiveWe aimed to develop and implement a theory-informed intervention intended to improve the movement behaviors and mental well-being of first-year postsecondary students. MethodsThe Intervention Mapping protocol was applied in the development and implementation of the intervention. Intervention Mapping entailed performing a needs assessment, determining the intervention outcomes, selecting theory- and evidence-based change methods and applications, preparing and producing intervention plans and materials, developing the implementation plan, and finally developing an evaluation plan. The Theoretical Domains Framework and the Behavior Change Wheel were also used in conjunction with the Intervention Mapping protocol to ensure a solid theoretical basis for the intervention. This protocol led to the development and implementation of a 6-week, theory-informed ParticipACTION app–based intervention aimed at helping first-year postsecondary students improve their movement behaviors and mental well-being. The developed app content provided students with information on each of the movement behaviors and behavioral strategies (ie, goal setting, action planning, monitoring, and coping planning). The use of Intervention Mapping allowed for the continuous involvement of various multidisciplinary partners and end users, ensuring that the intervention design and implementation was appropriate for the target audience. The feasibility, acceptability, and potential impact of the intervention will be examined in a subsequent proof-of-concept study at 2 Canadian university campuses. ResultsParticipant recruitment occurred during September 2021, and the intervention was conducted from October to December 2021. The deadline for completion of the postintervention questionnaire by participants was mid-December 2021. The analysis of data examining the feasibility, acceptability, and potential impact of the intervention began in January 2022, with the publication of the proof-of-concept evaluation expected in 2023. ConclusionsIntervention Mapping with the Theoretical Domains Framework and Behavior Change Wheel was a useful approach to combine evidence and theoretical concepts to guide the design and implementation of a ParticipACTION app–based intervention targeting postsecondary students’ movement behaviors and mental well-being. This process may serve as an example for other researchers developing multiple behavior change app–based interventions. Should the forthcoming evaluation demonstrate the intervention’s acceptability, feasibility, and potential impact, the intervention may provide a scalable method of improving postsecondary students’ movement behaviors and mental well-being. International Registered Report Identifier (IRRID)RR1-10.2196/39977

Abstract Aerobic and resistance exercise during and after cancer treatment are important for health-related outcomes, however treatment-specific barriers may inhibit adherence. We explored the effect of lower-frequency exercise training on fitness, body composition, and metabolic markers (i.e. glucose and lipids) in a group of recently diagnosed breast cancer patients. Fifty-two females ≥ 18 years with stage I–IIIB breast cancer were instructed to attend 2 cardiovascular and strength training sessions/week over 12 weeks, but program length was expanded as needed to accommodate missed sessions. Pre- and post-intervention, we measured: (1) cardiovascular fitness, (2) isometric strength, (3) body composition (dual-energy X-ray absorptiometry), and (4) fasting glucose, insulin, c-peptide, and lipids. Pre-intervention, participants were 53 ± 10 years old (mean ± SD) and overweight (BMI: 27.5 ± 5.4 kg m−2, 40.1 ± 6.5% body fat). Forty participants completed the program over a median 20 weeks (range: 13–32 weeks, median frequency: 1.2 sessions/week), over which predicted VO2peak improved by 7% (2.2[0.1–4.4] mL/kg/min) (delta[95% CI]), and strength increased by 7–9% (right arm: 2.3[0.1–4.5] N m; right leg: 7.9[2.1–13.7] N m; left leg: 7.8[1.9–13.7] N m). Body composition and metabolic markers were unchanged. An exercise frequency of 1.2 sessions/week stimulated significant improvements in fitness, and may represent a practical target for patients during active treatment.

Background: In addition to its physical health benefits, physical activity is increasingly recognized as a means to support mental health. Regular moderate-to-vigorous physical activity (MVPA) is associated with improved mental well-being, reduced likelihood of developing mental illness, and improved symptom management. Despite these benefits, most people fail to achieve minimum recommended levels of MVPA. Population levels of physical activity have further declined since the onset of the COVID-19 pandemic and implementation of public health measures (e.g., shelter-in-place protocols). The potential impact of this decline on mental heath outcomes warrants ongoing investigation.Purpose: To investigate associations between changes in MVPA and mental health (depressive symptoms, anxiety symptoms, and life satisfaction) in adults impacted by the COVID-19 pandemic.Method: Research followed a cross-sectional design. English-speaking adults were invited to complete an online questionnaire. MVPA was assessed retrospectively (before COVID-19) and currently (during COVID-19) with the International Physical Activity Questionnaire. Mental health was assessed with the Patient Health Questionnaire, 9-Item (PHQ-9), the Generalized Anxiety Disorder, 7-Item (GAD-7), and the Satisfaction with Life Scale (SWLS). Regression was used to assess relationships between MVPA and mental health. ANOVA with follow-up tests examined whether participants who differed in mental health status (e.g., no symptoms vs. severe symptoms) differed in their change in MVPA. T-tests were used to examine differences in mental health symptomatology between participants who were sufficiently (i.e., achieving MVPA guidelines of ≥ 150 min/week) vs. insufficiently active.Results: Prior to COVID-19, 68.2% of participants were classified as being sufficiently active, vs. 60.6% during COVID-19. The majority of participants reported experiencing some level of depressive symptoms (62.0%) or anxiety symptoms (53.7%). After controlling for covariates, changes in MVPA accounted for significant variability in the PHQ-9 (7.7%), GAD-7 (2.5%), and SWLS (1.5 %). Participants with clinically significant mental health symptomatology reported greater declines in MVPA than those who reported no symptoms. Conversely, participants who were sufficiently active during COVID-19 reported significantly lower depression and anxiety, and higher life satisfaction.Conclusion: Participants who experienced the greatest declines in MVPA reported relatively greater psychological distress and lower life satisfaction. While preliminary, these findings suggest the importance of maintaining and promoting physical activity during a period of pandemic.

Background: In response to the COVID-19 pandemic, physical distancing measures have been implemented globally. Canadians have been instructed to stay at home, which has likely resulted in significant changes in their physical activity. Using data from a national physical activity tracking app (PAC app), we aimed to determine device-measured physical activity levels immediately prior to and following the implementation of physical distancing measures in Canada to provide evidence for the development of physical activity recommendations for future pandemics or second wave infections.Methods: Demographic and physical activity data were extracted from the ParticipACTION app (PAC app), using a 10-week (10 February to 19 April 2020) quasi-experimental design to determine changes in physical activity 4 weeks pre-pandemic and 6 weeks post-pandemic declaration. Weekly physical activity levels were monitored through wearable fitness trackers and health apps linked to the PAC app, to record moderate-to-vigorous physical activity (MVPA), light physical activity (LPA), and steps. Repeated measure ANOVA was used to determine changes over time (mean ± SE).Findings: A total of 2,338 Canadians who were mostly 35–44 years old (26.6%) and female (90.2%) were included in the analysis. MVPA, LPA, and steps significantly declined immediately following the declaration of the pandemic (MVPA: pre-pandemic: 194.2 ± 5.2 min, post-pandemic: 176.7 ± 5.0 min, p < 0.001; LPA: pre-pandemic: 1,000.5 ± 17.0 min, post-pandemic: 874.1 ± 15.6 min, p < 0.001; steps: pre-pandemic: 48,625 ± 745 steps, post-pandemic: 43,395 ± 705 steps, p < 0.001). However, 6 weeks following pandemic declaration, MVPA (week 6: 204.4 ± 5.4 min, p = 0.498) had returned to pre-pandemic levels. LPA (week 6: 732.0 ± 14.3 min, p = < 0.001) and steps (week 6: 41,946 ± 763, p < 0.001) remained significantly lower than pre-pandemic levels at week 6.Interpretation: Although MVPA returned to pre-pandemic levels, significant and sustained declines in incidental LPA and steps were observed. Attenuating the loss of incidental physical activity should be a public health priority in response to future pandemics or a second wave of a COVID-19 infection, as it may have significant long-term implications for the physical and mental health of Canadians.

BackgroundUPnGO with ParticipACTION (UPnGO) was a commercialized 12-month workplace physical activity intervention, aimed at encouraging employees to sit less and move more at work. Its design took advantage of the ubiquitous nature of mobile fitness trackers and aimed to be implemented in any office-based workplace in Canada. The program was available at cost from June 2017 to April 2020. The objectives of this study are to evaluate the program and identify key lessons from the commercialization of UPnGO.MethodsUsing a quasi-experimental design over 3 time points: baseline, 6 months, 12 months, five evaluation indicators were measured as guided by the RE-AIM framework. Reach was defined as the number and percentage of employees who registered for UPnGO and the number and percentage of sedentary participants registered. Effectiveness was assessed through average daily step count. Adoption was determined by workplace champion and senior leadership responses to the off-platform survey. Implementation was assessed as the percentage of participants who engaged with specific program elements at the 3-evaluation time points. Maintenance was assessed by the number of companies who renewed their contracts for UPnGO.ResultsReach across 17 organizations, 1980 employees participated in UPnGO, with 27% of participants identified as sedentary at baseline. Effectiveness Daily step count declined from 7,116 ± 3,558 steps at baseline to 6,969 ± 6,702 (p =

The purpose of this study was to provide a detailed and systematic outline of how a theoretical behaviour change framework was applied in the development of ParticipACTION’s app to support a more active Canada. The app development process was guided by the Behaviour Change Wheel (BCW) framework, a theoretically-based approach for intervention development, in collaboration with the commercial app industry. Specifically, a behavioural diagnosis was used to understand what needs to change for the targeted behaviour to occur. Current literature, along with a series of surveys, and market research informed app development. Additionally, a validated app behaviour change scale, was consulted throughout development to help ensure app features maximized behaviour change potential. The behavioural diagnosis revealed that the app needed to target individuals’ physical and psychological capabilities, physical and social opportunities, and reflective and automatic motivations in order to increase physical activity levels. To accomplish this, 6 of a possible 9 intervention functions and 2 of 7 policy categories were selected from the BCW to be included in the app. Goals and planning, feedback and monitoring, behaviour identification, action planning and knowledge shaping were selected as the main behaviour change techniques for the app. Collaboration with a mobile app development firm helped to embed the selected behaviour change techniques, policy categories, intervention functions, and sources of behaviour within the app. Using a systematic approach, this study used the BCW to ensure the health promotion app was theoretically informed. Future research will evaluate its effectiveness in increasing the physical activity of Canadians.