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Purpose: Broad-reach (non-face-to-face) modalities offer an accessible and cost-effective means to provide behavior change programs in diverse and growing cancer survivor populations. The purpose of this systematic review is to evaluate the efficacy of physical activity, dietary, and/or weight control interventions for cancer survivors in which telephone, short-message service, print, and/or Web is the primary method of delivery., Methods: A structured search of PubMed, Embase, Web of Science, CINAHL, and CENTRAL (May 2013) was conducted. Included studies focused and reported on physical activity (PA) and dietary change and/or weight control in adult cancer survivors, delivered at least 50% of intervention contacts by broad-reach modality and included a control group. Study design, intervention features, and behavioral/weight outcomes were extracted, tabulated, and summarized., Results: Twenty-seven studies were included; 22 telephone, three Web, and two print. Sixteen studies targeted PA, two diet, and nine targeted multiple behaviors. Most studies (18/27) targeted a single survivor group, namely breast cancer (n = 12). Nineteen of 27 studies found evidence for initiation of behavior change, with only eight reporting on maintenance and one on cost-effectiveness., Conclusions: This review provides support for broad-reach modalities, particularly the telephone, in the delivery of lifestyle interventions to cancer survivors. Future research should evaluate (1) newer technologies (i.e., SMS and mobile phone applications), (2) interventions for diverse cancer survivors and those targeting multiple behaviors, (3) long-term outcomes, and 4) cost-effectiveness., Implications for Cancer Survivors: Broad-reach lifestyle interventions are effective, with further research needed to evaluate their generalizability and integration into cancer care.

Aims: To provide a systematic review and meta-analysis of recent evidence on the effectiveness of lifestyle-based weight loss interventions for adults with type 2 diabetes., Methods: A search of the literature from January 2003 to July 2013 was conducted (PubMed, Embase, CINAHL and Web of Science). The studies considered eligible were randomized controlled trials evaluating weight loss interventions (diet and physical activity, with or without behavioural strategies) of ≥12 weeks duration, compared with usual care or another comparison intervention. Ten studies were included for review. Some heterogeneity was present in the sample, therefore, random-effects models were used to calculate pooled effects., Results: Intervention duration ranged from 16 weeks to 9 years, with all but one delivered via individual or group face-to-face sessions. From six studies comparing lifestyle intervention with usual care the pooled effect on weight (n = 5795) was -3.33 kg [95% confidence interval (CI) -5.06, -1.60 kg], and on glycated haemoglobin (HbA1c; n = 5784) was -0.29% (95% CI -0.61, 0.03%), with both attenuated in sensitivity analyses. The pooled within-group effect on weight (n = 3063) from all 10 lifestyle intervention groups was -5.33 kg (95% CI -7.33, -3.34 kg), also attenuated in sensitivity analyses. None of the participant or intervention characteristics examined explained the heterogeneity. Only one study assessed whether intervention effects were maintained after the end of the intervention., Conclusions: Lifestyle-based weight loss intervention trials in type 2 diabetes achieve, on average, modest reductions in weight and HbA1c levels, but results were heavily influenced by one trial. Evidence-based approaches for improving the effectiveness of lifestyle-based interventions in type 2 diabetes are needed, along with future studies reporting on maintenance and cost-effectiveness., (© 2014 John Wiley & Sons Ltd.)

Background: Intensive lifestyle intervention trials in type 2 diabetes contribute evidence on what can be achieved under optimal conditions, but are less informative for translation in applied settings., Purpose: Living Well with Diabetes is a telephone-delivered weight loss intervention designed for real-world delivery., Methods: This study is a randomized controlled trial of telephone counseling (n = 151) versus usual care (n = 151); 6-month primary outcomes of weight, physical activity, HbA1c; secondary diet outcomes; analysis was by adjusted generalized linear models., Results: Relative to usual care, telephone counseling participants had small but significantly better weight loss [-1.12 % of initial body weight; 95 % confidence interval (CI) -1.92, -0.33 %]; physical activity [relative rate (RR) = 1.30; 95 % CI, 1.08, 1.57]; energy intake reduction (-0.63 MJ/day; 95 % CI, -1.01, -0.25); and diet quality (3.72 points; 95 % CI, 1.77, 5.68), with no intervention effect for HbA1c (RR = 0.99; 95 % CI, 0.96, 1.01)., Conclusions: Results are discussed in light of challenges to intervention delivery.

Most findings on associations of physical activity and sedentary behavior with the metabolic syndrome are from developed countries; thus, we examined these relationships in adults from Sur, Oman. The Sur Healthy Lifestyle Survey (n = 1,335) used the World Health Organization (WHO) Stepwise methodology to assess chronic disease risk factors. Odds ratios for the metabolic syndrome were estimated using logistic regression models for domains of physical activity (work, transport, and leisure) and sitting time, and adjusted for confounding variables. Compared to their counterparts doing the least physical activity, lower odds of the metabolic syndrome were observed among those with higher work activity (0.60; 95% confidence interval (CI): 0.45, 0.80) and transport activity (0.69; 95% CI: 0.47, 1.00), but not leisure activity (0.91; 95% CI: 0.64, 1.32). Odds of the metabolic syndrome were higher in those who sat for ≥ 6 h daily compared to <3 h daily (odds ratio = 1.60, 95% CI: 1.04, 2.44), but not after further adjustment for physical activity. This is the first evidence from the Arabian Gulf on associations of physical activity and sitting time with the metabolic syndrome and provides empirical evidence to inform national physical activity guidelines, policies and programs.

Background: Physically active individuals have lower rates of many cancers and improved cancer outcomes. Controlled exercise trials measuring putative biomarkers of cancer risk are being conducted to further understand the role of exercise in cancer etiology and progression. We aimed to systematically review the effect of exercise on various biomarkers., Methods: A comprehensive search strategy identified 353 publications from January 1980 to August 2010. We included those clinical trials of exercise measuring biomarkers following minimum 4-week intervention among cancer survivors or people with one or more cancer risk factors. Two reviewers abstracted data and assessed quality independently. Effect sizes and 95% confidence intervals were estimated., Results: Four primary prevention and five tertiary prevention trials were included. Exercise had a small to moderate effect on improving concentrations of several blood biomarkers implicated in breast and colon cancer pathways including insulin, leptin, estrogens, and apoptosis regulation. In breast cancer survivors, exercise had a small to moderate effect on improving some biomarkers associated with prognosis including various insulin-like growth factor axis proteins, insulin, and inflammation; and a large effect on enhancing immune function., Conclusion: Data are few, but there is some evidence to support the role of exercise in modulating various cancer pathways.

Rapid socioeconomic development in the countries of the Gulf Cooperation Council (GCC) has resulted in demographic and epidemiological transitions, with obesity, diabetes and other chronic diseases becoming the leading causes of morbidity and mortality. This emerging disease pattern is often attributed to physically inactive lifestyles. Given that there is no consolidated evidence on physical activity participation, we reviewed studies to examine prevalence and gender differences among GCC adults. PubMed, CINAHL and reference list searches identified eight relevant studies. Based on the best-available data, the prevalence of adults being physically active for at least 150 min week(-1) (based on the international standard definition) ranged from 39.0% to 42.1% for men and 26.3% to 28.4% for women. Men were significantly more active than were women. Prevalence estimates for participation in physical activity in the GCC States are considerably lower than those for many developed countries. Studies using standardized methodologies with nationally representative samples are urgently required. Identifying prevalence and gender variations provides the basis for understanding the unique socio-cultural and environmental factors contributing to physical inactivity among adults in the countries of the GCC. This understanding must then inform population-health strategies to address the rising prevalence of obesity, type 2 diabetes and other chronic diseases.

Background: We compared the responsiveness to change (prepost intervention) of 3 commonly-used self-report measures of physical activity., Methods: In a cluster-randomized trial of a telephone-delivered intervention with primary care patients, physical activity was assessed at baseline and 4 months (n = 381) using the 31-item CHAMPS questionnaire; the 6-item Active Australia Questionnaire (AAQ); and, 2 walking for exercise items from the US National Health Interview Survey (USNHIS). Responsiveness to change was calculated for frequency (sessions/week) and duration (MET x minutes/week) of walking and moderate-to-vigorous intensity physical activity., Results: The greatest responsiveness for walking frequency was found with the USNHIS (0.45, 95% CI: 0.19, 0.72) and AAQ (0.43, 95% CI: 0.19, 0.67), and for walking duration with the USNHIS (0.27, 95% CI 0.13, 0.41) and CHAMPS (0.24, 95% CI: 0.12, 0.36). For moderate-to-vigorous activity, responsiveness for frequency was slightly higher for the AAQ (0.50, 95% CI: 0.30, 0.69); for duration it was slightly higher for CHAMPS (0.32, 95% CI: 0.17, 0.47)., Conclusions: In broad-reach trials, brief self-report measures (USNHIS and AAQ) are useful for their comparability to population physical activity estimates and low respondent burden. These measures can be used without a loss in responsiveness to change relative to a more detailed self-report measure (CHAMPS).

Background: Major questions remain unanswered about how best to accomplish multiple behavior change. The purpose of this study was to evaluate whether there are differences in successfully changing multiple behaviors in computer-tailored sequential and simultaneous interventions for physical activity (PA) promotion and fat intake (FI) reduction., Methods: Participants (N=567) were randomly assigned to receive an intervention for PA and FI simultaneously; PA at baseline and FI at 3 months; or FI at baseline and PA at 3 months. Successful behavior change at 6 months was defined as: >60 min PA increase and/or 5% FI reduction. Using multinomial logistic regression the odds ratios of successful behaviors change (none, PA only, FI only, or both) were determined for intervention mode, gender, age, BMI and education., Results: Overall drop-out was 26%. There was no behavior change for 20.2% of participants; 30.5% successfully decreased FI; 15.8% successfully increased PA; 33.5% successfully changed both behaviors. Intervention mode, gender and age were not associated with successful behavior change. Compared to those that did not change any behaviors: participants that successfully changed FI were more likely to be overweight/obese (OR=1.85); and participants that successfully changed both behaviors were more likely to be overweight/obese (OR=2.13) and have lower education (OR=2.46)., Conclusions: Success in changing multiple behaviors was not associated with intervention mode; both simultaneous and sequential interventions can be applied. Being overweight might be an extra motivator to change health behaviors.