Browsing by Author "Leach, Heather, advisor"
Now showing 1 - 8 of 8
Results Per Page
Sort Options
Item Embargo Effect of a videoconference-delivered physical activity intervention on quality of life in colorectal cancer survivors(Colorado State University. Libraries, 2023) Prien, Lydia, author; Leach, Heather, advisor; Schmid, Arlene A., committee member; Zimmaro, Lauren A., committee memberINTRODUCTION: Colorectal cancer is the fourth most common cancer diagnosed in both men and women in the United States. For every 100 people diagnosed with colon cancer, 64 are expected to live five or more years after diagnosis. With this growing number of colorectal cancer survivors, quality of life (QOL) becomes an important patient reported outcome within this population. QOL is multidimensional and includes various dimensions of wellbeing (e.g., physical, emotional, social) that can be improved with physical activity. Previous research has established that face-to-face supervised physical activity (PA) interventions can improve QOL among colorectal cancer survivors (CRC) (Mishra et al., 2012). However, these interventions require a lot of resources, and may be difficult to access. Thus, researchers have turned to distance-based physical activity (PA) interventions (digital health tools, text messaging, prerecorded home-based workouts etc.) to increase access and scalability of PA interventions for CRC survivors. Previous studies that have examined the effect of distance-based PA interventions for improving QOL in CRC survivors did not find improvements in QOL. For example, Kim et al. (2019) found no significant improvements in QOL following an unsupervised, homebased, DVD exercise program, and Chan et al. (2022) found no significant changes in QOL, following a text messaging intervention. These finding suggest that distance-based PA interventions may not be as effective as face-to-face for improving QOL in CRC survivors and may be due to a lack of contact with other survivors and/or diminished PA adherence/compliance due to lack of supervision and instruction from an exercise professional. Since the COVID-19 pandemic, videoconference PA interventions have grown in popularity, and may be able to overcome some of the limitations of both face-to-face and distance-based PA interventions for improving QOL in CRC survivors. However, to date there are no previous studies that have examined the effect of a videoconference intervention on QOL in CRC survivors. This study will examine changes in QOL in colorectal cancer survivors following a 12-week, videoconference, PA intervention. This study will be a secondary data analysis of participants enrolled in Testing Group Activity CorrelaTes In Colorectal Cancer Survivors (TACTICS), a pilot randomized controlled trial with the primary aims of determining feasibility, and preliminary effects on physical activity. METHODS: TACTICS is a 12-week pilot randomized controlled trial where the intervention group received group-based exercise sessions 2x/week, and five behavior change discussion sessions delivered via Zoom. The control group received standard physical activity recommendations. QOL was measured at baseline and 12-weeks using the Functional Assessment of Cancer Therapy–Colorectal (FACT-C). Mean change, standard deviation, and effect size were reported to measure improvements in QOL. Established minimal clinically important differences (MCID) are a Δ5 points for total and a Δ2 points for QOL subscales. The proportion achieving MCID's in intervention vs. control were compared using Fisher's Exact tests, and independent t-tests or chi square tests explored differences in participant characteristics between those did vs. did not achieve MCID. RESULTS: Participants (n= 13 intervention, n=12 control) were mostly 56% female and M=61.2±11.7 years old. Among intervention participants, proportion who achieved MCID was 23.1% total, 15.4% physical, 38.5% functional, 23.1% social, and 15.4 % emotional, compared to 41.7% total, 33.3% physical, 25.0% functional, 41.7% social wellbeing, and 16.7% emotional among control. None of these proportions differed between groups (p>.05). For the physical QOL subscale, BMI was higher [t(11)=2.92, p=.014] and baseline scores were lower [t(7)=-2.34, p=.052] among those who achieved MCID. CONCLUSION: We observed small improvements in QOL within CRC survivors. There were no statistically significant differences in achieving clinically relevant improvements in QOL between intervention and control group participants. Larger randomized studies are needed to definitively determine if a videoconference exercise intervention can elicit clinically relevant improvements in QOL compared to a control group.Item Open Access Effectiveness of a low dose behavior change intervention on physical activity maintenance following an exercise trial in pre-type II diabetics(Colorado State University. Libraries, 2017) Sanders, Ashley B., author; Leach, Heather, advisor; Nelson, Tracy, advisor; Graham, Daniel, committee memberPre-type II diabetes (PT2D) is emerging as one of the fastest growing chronic diseases among adults. Increasing physical activity (PA) levels is often a first line of defense for managing PT2D; however, PA levels in this population are below the national average. PA behavior change (PABC) interventions can be useful in assisting with the adoption and maintenance of regular PA, yet the feasibility and effectiveness of embedding a low dose PABC within an exercise efficacy trial for PT2D has not been examined. The main purpose of this study is to determine the effectiveness of one PABC counseling session on PA maintenance following a 12-week exercise efficacy trial. This study also aims to examine changes in self-efficacy following the PABC counseling session. Finally, this study aims to explore both social support and perceptions of neighborhood walkability as determinants of PA following an exercise trial. Participants were randomized to receive a one-hour PABC counseling session, or not (CON), held after completion of the 12-week exercise trial. The session was based on social-cognitive theory, and the primary goal was to increase post-intervention PA maintenance through discussion of PA benefits, PA goal setting, and identifying and overcoming PA barriers. Self-reported PA was measured using the International PA Questionnaire (IPAQ), pre, post and three-months after the exercise trial. Participants also completed questionnaires assessing self-efficacy, social support and neighborhood walkability. Baseline, post-intervention questionnaires, and the PABC counseling session were done while participants were in the laboratory doing their oral glucose tolerance test, and the follow-up questionnaire was completed by mail or online. Participants (N=21, M Age = 62±5.8), were mostly female (86%), Caucasian (88%), and high socioeconomic status (70.6% completed at least 4 years of college, and 76.5% had an annual household income ≥ $50,000). Paired t-tests detected a significant difference in total PA between post-intervention to follow-up, t(15) = 3.33, p = .005, with total PA decreasing from post to follow-up for the entire sample. No significant within group changes (N=16; PABC N=8, CON N=8) were found between post and follow-up. Repeated measures analysis of variance (ANOVA) did not detect statistical significance between groups in total PA change from post-intervention to three-month follow-up, F(1, 14) = 2.93, p = .109. Barriers self-efficacy significantly improved from before to after the PABC, t(12) = -2.63, p = .022. Social support, neighborhood crime and neighborhood aesthetics were significantly associated with PA measures at three-month follow-up. Incorporating a single session PA behavior change intervention as part of an exercise efficacy trial is feasible. While the PABC counseling session did not result in a lower rate of total PA decline from post to follow-up, those who received the PABC did report higher levels of PA at follow-up. Self-efficacy, social support and perceptions of neighborhood walkability are important determinants of PA maintenance in adults at risk of developing type-II diabetes. Future studies should explore the dose response of PABC counseling sessions in this population to determine the lowest dose needed to enhance PA maintenance following an exercise trial.Item Open Access Exploring cancer survivors' preferences for a physical activity maintenance program(Colorado State University. Libraries, 2023) Anderson, Hadalyn, author; Leach, Heather, advisor; Fruhauf, Christine, committee member; Faro, Jamie, committee memberPurpose: Physical activity (PA) offers long-term health benefits for cancer survivors (CS), if sustained. Community-based exercise programs have shown short-term effectiveness in increasing PA among cancer survivors, but evidence of their effect on long-term PA engagement (i.e., PA maintenance) is lacking. This study (1) quantitatively explored cancer survivors' preferences for a PA maintenance program and whether preferences were impacted by PA levels, and (2) qualitatively explored participants' preferences of a PA maintenance program and PA-related barriers. Methods: CS who completed one of three original cancer-specific community-based exercise programs participated in a pilot PA maintenance program (i.e., two exercise and discussion sessions). (1) Participants completed questionnaires via REDCap database to assess interest in a PA maintenance program (i.e., likelihood of attending, perceived helpfulness and enjoyment, and preferences of frequency, duration, and time until maintenance program commencement) and PA levels. Participants reported current PA levels compared to when they finished the original program (greater or same vs. lower PA levels) and completed the Godin Leisure-Time Exercise Questionnaire to determine whether they were currently meeting PA guidelines (≥150 mins/week of moderate aerobic PA + 2 days of strength training). (2) Participants also completed semi-structured focus groups via Zoom that aimed to answer the following questions regarding participants': (i) maintenance program experience, (ii) suggestions for future maintenance program implementation, (iii) perceived elements of the original program that were helpful in maintaining PA, and (iv) barriers experienced following the original program. Frequencies from (1) were calculated, and Fisher's exact tests were used to compare proportions between maintenance program preferences and participants' PA levels. Qualitative data from (2) were transcribed verbatim, coded inductively, and analyzed using thematic analysis. Themes and frequencies of references (%) were calculated. Results: (1) Participants (N=20) were M=60±13 years old, non-Hispanic White (95%), female (95%), and diagnosed with breast (50%), ovarian (20%), or other (30%) cancer. Average time since program completion was M=26.2 ± 35.7 (1-110) months. Most participants (65%) reported exercising more or the same amount since original program completion, and 35% met PA guidelines. The majority were likely to attend maintenance exercise (90%) and discussion (80%) sessions. All (100%) participants thought maintenance exercise sessions would be helpful and most (85%) for discussion sessions. There were no differences in responses based on PA levels (all p>.05). (2) Themes identified for (i) were Accountability (36%), Shared Cancer Survivor Experience (26%), Individualized Exercise Prescription (30%), and Discussion Session Content (8%); (ii) were Accountability (8.929%), Discussion Session Content (26.79%), and Discussion (19.64%) and Exercise (44.64%) Session Delivery; (iii) were Accountability (39.39%), Individualized Exercise Prescription (30.3%), and Discussion Session Content (30.3%); and (iv) were Psychological (41.38%), Physical (27.59%), and Environmental (31.03%). Conclusion: Participants had positive perceptions of the maintenance program. Future studies should measure effectiveness of a maintenance program to support PA maintenance and encompass program leader perspectives to work towards achieving pragmatic solutions to maintain PA maintenance programs within community-based settings.Item Open Access Feasibility, acceptability and preliminary effectiveness of a video conference delivered, group-based physical activity program for cancer survivors(Colorado State University. Libraries, 2021) Howell, Matthew, author; Leach, Heather, advisor; Perry, Rick, committee member; Currin-McCulloch, Jen, committee memberBackground: Although supervised cancer rehabilitation and exercise programs are effective for improving health outcomes among cancer survivors, widespread access is lacking, and the COVID-19 pandemic highlighted the need for innovative ways to reach and serve cancer survivors in their homes. Method: A single arm, pre-post study to assess feasibility, acceptability and preliminary effectiveness of Fitness for Cancer Therapy (Fit Cancer), an 8-week, group-based videoconference delivered exercise program. Feasibility and acceptability were captured by accrual, attendance and adherence rates and participant satisfaction and analyzed using descriptive statistics. Preliminary estimates of the effects of Fit Cancer on physical function, Quality of Life (QOL) and Exercise Self Efficacy (ESE) were measured at pre- and post-program and analyzed by percent change and one-tailed, paired sample t-tests. Results: A total of n = 39 participated in the study. Accrual (91%), retention (90%), adherence (88%) rates along with acceptability (94%) findings support feasibility. Physical activity measured by moderate-vigorous aerobic and resistance exercise had a percent change increase of 69.9% (p <0.05). Lower (10.4%, p <0.05) and upper body muscular endurance (22.4%, p <0.05) and single-leg balance (12.1%, p <0.05) all increased significantly. No changes were seen in QOL or BARSE and a reduction was seen in ESE (-8.1%, p <0.05). Conclusion: Results indicate that a videoconference delivered exercise program was feasible and acceptable and may help cancer survivors increase physical activity and muscular strength/endurance. A controlled trial is required to confirm these findings.Item Open Access Improving physical activity maintenance following an exercise program for cancer survivors: a pragmatic hybrid randomized controlled trial(Colorado State University. Libraries, 2020) McGinnis, Emma L., author; Leach, Heather, advisor; Fruhauf, Christine, committee member; Rogers, Laura, committee member; Jankowski, Catherine, committee memberPurpose: Supervised exercise programs can help cancer survivors increase physical activity (PA), but maintaining PA following program completion is challenging. Randomized controlled trials have shown that adding behavior change counseling to supervised exercise can improve PA maintenance in cancer survivors, however, translating this work to real-world settings remains a challenge. This study examined (1) the feasibility and acceptability of implementing six, evidence-based PA behavior change counseling (PABCC) sessions into BfitBwell, an existing exercise program for cancer survivors, and (2) the effects of PABCC on post-program self-efficacy and outcome expectations, and on PA, 3-months following program completion. Methods: Cancer survivors enrolled in BfitBwell were randomized to receive (1) the current BfitBwell program, or (2) BfitBwell plus six PABCC sessions. Feasibility was assessed by participant representativeness, process fidelity, time and cost to adapt and deliver the PABCC sessions, and a focus group with BfitBwell staff. Acceptability was based on reasons for declining participation, adherence, and participant satisfaction. Barriers self-efficacy, exercise self-efficacy, outcome expectations, and PA were assessed via validated questionnaires at baseline, post-program, and 3-month follow-up (PA only). Quantitative feasibility and acceptability data were summarized using descriptive statistics and qualitative data were analyzed using thematic content analysis. Paired sample t-tests examined within group changes in self-efficacy and outcome expectations. Change in minutes of moderate to vigorous PA (MVPA) was calculated by subtracting MVPA at post-program from 3-month follow up, and the percent of participants meeting PA guidelines was calculated. Results: Out of (N=33) who enrolled, N=13 completed the post-program assessment, and N=9 completed the 3-month follow-up exercise questionnaire. Based on the staff focus group and study evaluation questionnaire, PABCC was well accepted and the idea of incorporating a behavior change component into BfitBwell was well supported by program staff. However, due to low enrollment rates (35%), reasons for declining participation such as "unable to make class time", and the staff time associated with delivering PABCC sessions, implementation of the sessions in their current form may not be feasible. There was no significant change in self-efficacy or outcome expectation measures from baseline to post-program. Minutes of MVPA tended to decline from post-intervention to three-month follow-up in both BfitBwell + PABCC (-81.7 ± 240.6) and control (-45.0 ± 63.7), however PA response was highly variable. Additional research to explore alternative PABCC delivery strategies such as virtual delivery modalities or a condensed PABCC format in the context of existing exercise programs is needed. Further, a study with a larger sample size is needed to confirm the effectiveness of adding PABCC to BfitBwell on PA maintenance.Item Open Access Movement for mobility: associations between physical activity, postural control, and gait in people with multiple sclerosis(Colorado State University. Libraries, 2021) Bandera, Victoria Maria, author; Fling, Brett, advisor; Leach, Heather, advisor; Diehl, Manfred, committee memberBackground: Approximately 80% of people with multiple sclerosis (PwMS) experience impaired balance and mobility. The optimal duration, type and intensity of physical activity (PA) to improve balance and gait is not well understood. Purpose: Examine associations between PA duration, type and intensity with balance and gait in PwMS and neurotypical controls. Methods: Twenty-four PwMS and twenty-one neurotypical controls reported their typical PA routine, including duration [(days/week)x(minutes/bout)], type (aerobic, resistance and/or plyometric (R/P) and yoga), and intensity (rating of perceived exertion (RPE) 6-20). Balance was assessed by the mini Balance Evaluation Systems Test (Mini-BESTest). Gait speed was measured by the two-minute walk test at a normal pace and a fast pace. Pearson's and Spearman's correlations examined associations among PA variables, balance, and gait speed. Independent t-tests and Mann-Whitney U tests examined differences in gait speeds and balance, between participants who did vs. did not perform each PA type. MANOVA and Kruskal-Wallis tests compared gait and balance performance in participants who reported ≥150 PA minutes/week, and vigorous PA (RPE > 14) vs. those who did not. Results: No significant associations were found between PA duration and any outcomes in either group. Conversely, PA intensity was significantly associated with reactive postural control, rs(24) = .458, p < .05, sensory orientation, rs (24) = .487, p < .05, and dynamic gait, rs(24) = .429, p < .05, and anticipatory postural control in neurotypical controls, rs(21) = .476, p < .05. As for PA type, self-reported habitual R/P was associated with nearly significantly superior dynamic gait performance in PwMS, p = .07, but significantly lower normal gait speed in neurotypical controls, p < .05. Participants who met and/or exceeded the 150-minute per week PA guideline did not have differences in any outcomes. Habitually vigorous PA was associated with significantly improved anticipatory postural control, H(1) = 5.86, p < .05, and nearly significantly improved Mini-BEST scores in neurotypical participants H(1) = 3.273, p = 0.07. Minimally clinically important differences in fast gait speed (> 0.10 m/s) were found in neurotypical participants habitually performing vigorous PA compared to light-to-moderate PA. Conclusions: These findings suggest PA intensity and participation in R/P and yoga are associated with better balance and gait performance. Future studies should reevaluate these associations incorporating PA intensity measured by self-report perceived intensity and objectively measured, and incorporating R/P training into PA routines to improve balance and gait outcomes in PwMS.Item Open Access Reallocating time to physical activity and sleep: associations with quality of life and body mass index in cancer survivors(Colorado State University. Libraries, 2021) Hidde, Mary, author; Leach, Heather, advisor; Broussard, Josiane, committee member; Lyden, Kate, committee member; Henry, Kim, committee memberIntroduction: Quality of Life (QOL) and Body Mass Index (BMI) are important outcomes for cancer survivors due to their association with cancer-related morbidity and mortality. Lifestyle behaviors including physical activity (PA), sedentary time, and sleep are all potential intervention targets to improve QOL and BMI. The effect of these activities on QOL and BMI is most often studied in isolation despite the interdependent nature of these behaviors; time cannot be increased in one activity without decreasing time in another. Since these behaviors are often studied in isolation, it is difficult to assess if an improvement in QOL or BMI is attributed to increasing positive behaviors (i.e., PA or sleep), or decreasing negative behaviors (i.e., sedentary time). The growing interest around 24-hour activity patterns has increased researcher interest in objective measurement of PA and sleep using accelerometers. However, this currently requires researchers to utilize one device to measure sleep (i.e., Actiwatch) and one to measure waking behaviors (i.e., activPAL). This has led to high research costs and burden since the Actiwatch cannot measures waking behaviors and, until recently, the activPAL could not detect time in bed (TIB), limiting researcher's ability to objectively collect 24-hour activity data. In order to move the world of 24-hour activity forward and delineate the role time reallocations throughout the day affect pertinent cancer-related outcomes, additional research must be conducted to explore solutions to the high research costs and burden associated with 24-hour activity measurement. Therefore, the purpose of this dissertation is to (1) evaluate if the new activPAL algorithm designed to measure TIB can estimate TIB similarly to the valid and reliable Actiwatch and 2) evaluate, using an Isotemporal substitution model, the effects of reallocating time from one activity to another on QOL and BMI using accelerometry (Actiwatch and activPAL pending results of aim 1) to measure 24-hour activities. Methods: The activPAL algorithm's ability to measure TIB was evaluated using a cross-sectional analysis of participants (n=85) undergoing a time-restricted feeding study. Participants (for all studies) wore the activPAL accelerometer to measure waking behaviors and the Actiwatch to measure sleeping behaviors for 7 days, 24-hours per day. Repeated measures mixed effects models and Bland-Altman plots were used to compare the activPAL TIB estimates to the Actiwatch TIB estimate with type of device and day of wear as fixed effects and participant as a random effect. TIB results were then utilized in a cross-sectional analyses of cancer survivors (n=73) within 60 months of surgery, chemotherapy, and/or radiation. In addition to wearing the activPAL and Actiwatch, participants completed the Functional Assessment of Cancer Therapy-General (FACT-G) to measure QOL. Participants self-reported height and weight to calculate BMI. Demographics were calculated using mean ± standard deviation or frequencies (%). Isotemporal substitution models were used to evaluate the effects of reallocating 30 minutes of each activity to another. Statistical significance for all studies was set at p<.05. Results: The activPAL accelerometer does not estimate TIB similarly to the Actiwatch. Additionally, no significant interaction was observed for type of accelerometer and day of wear. There were no statistically significant reallocations for total QOL score or the included subscales. However for BMI, reallocating 30 minutes of sleep to sedentary time or moving 30 minutes of sedentary time to light PA did result in statistically significant changes in BMI. There were no statistically significant reallocations by moving moderate-vigorous PA to other activities of interest. Despite no statistical significance for QOL, reallocating time from sedentary time or light PA to MVPA resulted in clinically meaningful increases in QOL (>4 points). Conclusion: Estimates of TIB from the activPAL and Actiwatch accelerometers were not similar, suggesting that researchers who are interested in the 24-hour activity cycle will continue to require the use of both accelerometers to measure both sleep and active/waking behaviors. Results of reallocating time on QOL and BMI indicate that in addition to MVPA, sleep, and light PA are essential behaviors for cancer survivors. The work presented in this dissertation can provide a starting point for the development of 24-hour activity guidelines for improving BMI and QOL in cancer survivors; however, additional time reallocation studies using a larger sample size in order to include bouted and non-bouted activity time as well as more detailed measures of body composition (i.e., dual x-ray absorptiometry) are needed to further understand the role the 24-hour activity cycle has on BMI and QOL in cancer survivors.Item Open Access Reasons for joining and adhering to a community-based fitness program among middle-aged and older adults(Colorado State University. Libraries, 2024) Kirksey, Zoe, author; Leach, Heather, advisor; Burke, Kimberly, committee member; Brothers, Allyson, committee memberPurpose: Community-based fitness (CBF) programs address common barriers to physical activity (PA) participation for middle-aged and older adults and can help to increase regular PA. However, engagement in CBF programs among middle-aged and older adults is suboptimal, and those who do join tend to not adhere long-term. This study examined reasons for joining and adhering to a CBF program and explore common characteristics among long-term members. Methods: Observational, cross-sectional cohort study. Participants were monthly paying members of Adult Fitness, a CBF program at Colorado State University. Participants completed a 24-question quantitative survey, and monthly membership length was determined from participant records. To determine reasons for joining and adhering to Adult Fitness, two 5-point Likert scale questions, on a scale from 1(not motivated at all) to 5 (extremely motivated) were used. The response options were the same and consisted of unique aspects of Adult Fitness and replicated responses from a previous study. Frequency statistics were run on both questions and "motivated a great deal" and "extremely motivated" percentages were summed to determine most prevalent reasons for joining and most prevalent reasons for adhering. Long-term adhering members were defined as having a membership length of ≥5 years, and common characteristics were determined by a response that had more than a 50% response rate. Frequency statistics were run on survey questions to determine common characteristics. Results: The survey was distributed to N=151 members, and N=95 returned, for a response rate of 62%. There were n=8 duplicate and incomplete surveys, leaving a total of N=88 surveys included in analyses. Respondents were 70.5% older adults, 65+, 26.1% middle-aged adults, 35-64, and 3.4% young adults 18-34. Respondents were 50% female, and 50% male and average membership length was 132 months, 11 years (SD=142.8 months; range=563 months). For aim 1, the most frequently reported reasons for joining the Adult Fitness program were facilities available which 79.3% selected "motivated a great deal" or "extremely motivated", followed by self-initiated search for an activity program, 74.7%, and low cost, 60%. Most frequently reported reasons for adhering, were self-initiated desire to promote fitness and/or overall health, 95.4%, facilities available, 80.4%, and low cost, 60%. For aim 2, long-term adhering members (N=58) were motivated to join due to facilities available or self-initiated search for an activity program, motivated to adhere due to self-initiated desire to promote fitness and/or overall health, facilities available, and low cost, reported their current physical as either "good" or "very good", selected either "improvement of health" or "help me stay active" as their most perceived benefit of participating in Adult Fitness, attended the program on average of 3-days a week, and participated in 21-60 min of physical activity (PA) outside of Adult Fitness per day. Conclusion and Clinical Implications: The current study offers valuable insight to CBF program staff and organizational leaders. Understanding motivators of joining and adhering to CBF programs can contribute to tailoring these programs to increase membership and promote long-term participation/membership. These strategies may include offering competitive pricing, adding to existing facilities to cater to interest or needs of members and providing educational resources and progress tracking tools to keep members informed of their health status and/or improvement. Future studies are needed to better understand reasons for discontinuing CBF program.