Category: Publications

Illinois News Bureau | Physical activity could combat fatigue, cognitive decline in cancer survivors

DE_EMA new study indicates that cancer patients and survivors have a ready weapon against fatigue and “chemo brain”: a brisk walk. Continue.


Rogers, L.Q., Courneya, K.S., Anton, P.M., Hopkins-Price, P., Verhulst, S., Vicari, S.K., Robbs, R.S., Mocharnuk, R., & McAuley, E. (2015). Effects of the BEAT Cancer physical activity behavior change intervention on physical activity, aerobic fitness, and quality of life in breast cancer survivors: a multicenter randomized controlled trial. Breast Cancer Res Treat, 149(1), 109-19.

Most breast cancer survivors (BCS) are not meeting recommended physical activity guidelines. Here, we report the effects of the Better Exercise Adherence after Treatment for Cancer (BEAT Cancer) behavior change intervention on physical activity, aerobic fitness, and quality of life (QoL). Werandomized 222 post-primary treatment BCS to the 3-month intervention (BEAT Cancer) or usual care (UC). BEAT Cancer combined supervised exercise, face-to-face counseling, and group discussions with tapering to home-based exercise. Assessments at baseline, immediately post-intervention (month 3; M3), and 3 months post-intervention (month 6; M6) included accelerometer and self-reported physical activity, submaximal treadmill test, and QoL [Functional Assessment of Cancer Therapy (FACT)-Breast scale]. Adjusted linear mixed-model analyses demonstrated significant effects of BEAT Cancer compared to UC on weekly minutes of ≥moderate intensity physical activity at M3 by accelerometer [mean between group difference (M) = +41; 95 % confidence interval (CI) = 10-73; p = 0.010] and self-report (M = +93; CI = 62-123; p < 0.001). Statistical significance remained at M6 for self-reported physical activity (M = +74; CI = 43-105; p < 0.001). BEAT Cancer participants were significantly more likely to meet physical activity recommendations at both time points [accelerometer M3 adjusted odds ratio (OR) = 2.2; CI = 1.0-4.8 and M6 adjusted OR = 2.4; CI = 1.1-5.3; self-report M3 adjusted OR = 5.2; CI = 2.6-10.4 and M6 adjusted OR = 4.8; CI = 2.3-10.0]. BEAT Cancer significantly improved fitness at M6 (M = +1.8 ml/kg/min; CI = 0.8-2.8; p = 0.001) and QoL at M3 and M6 (M = +6.4; CI = 3.1-9.7; p < 0.001 and M = +3.8; CI = 0.5-7.2; p = 0.025, respectively). The BEAT Cancer intervention significantly improved physical activity, fitness, and QoL with benefits continuing 3 months post-intervention.

Gothe, N.P., Wójcicki, T.R., Olson, E.A., Fanning, J., Awick, E.A., Chung, H.D., Zuniga, K.E.,  Mackenzie, M.J., Motl, R.W., & McAuley, E. (2015). Physical activity levels and patterns in older adults: the influence of a DVD-based exercise program. J Behav Med, doi: 10.1007/s10865-014-9581-6.

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Abstract: The use of multimedia to influence health behaviors offers unique advantages over more traditional center-based programs, however, little is known about the effectiveness of such approaches in improving physical activity levels over time. The purpose of this study was to examine the efficacy of a progressive and age-appropriate, DVD-delivered exercise program in promoting physical activity levels among older adult cohorts. Community dwelling older adults (N = 307, Mean age = 71 years) were randomized to one of two groups: a 6-month home-based DVD-delivered exercise (i.e., FlexToBa™) intervention group or a healthy aging DVD control group. Physical activity was assessed objectively using a standard 7-day accelerometer wear period and subjectively using the Godin Leisure Time Exercise Questionnaire, at baseline and follow-up. Analysis of covariances indicated a statistically significant treatment effect for subjectively [F(1,250) = 8.42, P = .004, η(2) = .03] and objectively [F(1,240) = 3.77, P = .05, η(2) = .02] measured physical activity. The older cohort (>70) in the FlexToBa condition further had significantly larger improvements in physical activity levels compared to their younger counterparts. From a public health perspective, media-delivered interventions such as the FlexToBa program might prove to be cost-effective, have a broader reach and at the same time be effective in improving physical activity levels in older adults.

Wójcicki, T.R., Fanning, J., Awick, E.A., Olson, E.A., Motl, R.W., & McAuley, E. (2014). Maintenance effects of a DVD-delivered exercise intervention on physical function in older adults. J Gerontol A Biol Sci Med Sci, doi: 10.1093/gerona/glu188.

1flextobaBackground: Exercise training has been demonstrated to enhance physical function and to have a protective effect against functional limitations and disability in older adults. Purpose: The objective of this study was to determine whether the effects of a home-based, DVD-delivered exercise intervention on functional performance and limitations were maintained 6-month postintervention termination. Methods: Follow-up assessments of functional performance and limitations were conducted in a sample of community-dwelling older adults (N = 237) who participated in a 6-month randomized controlled exercise trial. Participants were initially randomized to a DVD-delivered exercise intervention or an attentional control condition. The Short Physical Performance Battery, measures of flexibility and strength, and functional limitations were assessed immediately before and after the intervention and then again 6 months later. Analyses of covariance were conducted to examine changes in physical function between the two conditions at the end of the intervention to 6-month follow-up. Results: There were statistically significant adjusted group differences in the Short Physical Performance Battery (η2 = 0.03, p = .01), upper-body strength (η2 = 0.03, p = .005), and lower-body flexibility (η2 = 0.02, p = .05), indicating that gains brought about by the intervention were maintained 6 months later. Conclusions: A DVD-delivered exercise program specifically designed to target elements of functional fitness in older adults can produce clinically meaningful gains in physical function that are maintained beyond intervention cessation.

Awick, E.A., Wójcicki, T.R., Olson, E.A., Fanning, J., Chung, H.D., Zuniga, K., Mackenzie, M., Kramer, A.F., & McAuley, E. (2014). Differential exercise effects on quality of life and health-related quality of life in older adults: a randomized controlled trial. Quality of Life Research.

QOLRJPurpose: Maintaining quality of life (QOL) and physical and mental health status are important outcomes throughout the aging process. Although cross-sectional studies suggest a relationship between global QOL and physical activity, it is unclear whether such a relationship exists as a function of exercise training. Methods: We examined the effects of two exercise intervention arms on health-related quality of life (HRQOL) and global QOL. Low-active, older adults (n = 179) were randomly assigned to either a 12-month aerobic walking group or a strengthening and flexibility group. HRQOL and QOL were measured at baseline, 6, and 12 months. Results: There was a significant group by time effect on QOL [F(2,176) = 3.11, p = 0.047, η 2 = 0.03]. There was also a significant overall group by time effect for HRQOL [F(4,174) = 2.46, p = 0.047, η2 = 0.05], which was explained by the significant group by time interaction for mental health status (p = 0.041, η 2 = 0.02) favoring the walking condition. Further analyses using latent class analysis revealed three classes of individuals with differential patterns of change in QOL and HRQOL across time. These classes reflected no change, declines, and improvements in these constructs across time. Conclusions: Walking appears to enhance the mental aspect of HRQOL and global QOL when compared to a non-aerobic intervention. Additionally, the patterns of change in QOL and HRQOL were not linear over time. Our findings are in contrast to previous reports that these outcomes change a little or not at all in randomized trials.

Fanning, J. & McAuley, E. (2014). A comparison of tablet computer and paper-based questionnaires in healthy aging research. JMIR Research Protocols, 3(3), 38.


Background: Digital questionnaire delivery offers many advantages to investigators and participants alike; however, evidence supporting digital questionnaire delivery via touchscreen device in the older adult population is lacking. Objective: The objective of this study was to compare the use of tablet computer-delivered and printed questionnaires as vehicles for the collection of psychosocial data from older adults to determine whether this digital platform would be readily adopted by the sample, and to identify whether tablet delivery influences the content of data received. Methods: The participants completed three questionnaires using both delivery methods, followed by a brief evaluation. Results: A nonparametric one-sample binomial test indicated a significantly greater proportion of individuals preferred the tablet-delivered questionnaires (z=4.96, SE 3.428, P<.001). Paired sample t tests and Wilcoxon sign-rank tests indicated that measures collected by each method were not significantly different (all P≥.273). Ease of use of the tablet interface and anxiety while completing the digital questionnaires were significantly correlated with preferences, (rs=.665, P<.001 and rs=.552, P<.001, respectively). Participants most frequently reported that the tablet delivery increased speed of use and improved data entry, although navigation was perceived as being more difficult. By comparison, participants felt that the paper packet was easier to read and navigate, but was slow and cumbersome, and they disliked the lack of dynamic features. Conclusions: This study provides preliminary evidence suggesting that questionnaires delivered to older adults using contemporary tablet computers may be acceptable and do not substantively influence the content of the collected data.

McAuley, E., Wójcicki, T. R., Gothe, N. P., Mailey, E. L., Szabo, A. N., Fanning, J., Olson, E.O., Phillips, S. M., Motl, R. W., & Mullen, S.P. (2013). Effects of a DVD-delivered exercise intervention on physical function in older adults.  J Gerontol A Biol Sci Med Sci doi:10.1093/gerona/glt014.flextoba

Background: Given the rapidly increasing demographic of older adults, it is vital to implement effective behavioral strategies to improve physical function to maintain activities of daily living. However, changing physical activity in older adults remains extremely difficult. The current trial tested the efficacy of a novel, 6-month, home-based, DVD-delivered exercise program focusing on flexibility, balance, and toning on the physical function of older adults. Methods: Older adults (N = 307) were recruited from 83 towns and cities throughout central Illinois. The trial consisted of 4 waves of recruitment and randomization from May 2010 through January 2012. Inclusion criteria included being inactive, at least 65 years of age, English speaking, providing physician’s consent, and willingness to be randomized. Eligible participants were randomly assigned to 1 of 2 treatment conditions: the exercise intervention or a healthy aging, attentional control. Functional assessments were completed at baseline and following the 6-month DVD intervention. Measures included the Short Physical Performance Battery, assessments of flexibility and strength, and self-reported functional limitations. Results: Participants in the DVD intervention condition demonstrated significant improvements in the Short Physical Performance Battery (p = .005), lower extremity flexibility (p = .04), and upper body strength (p = .003). There were no effects of the intervention on self-reported functional limitations. Conclusions: The exercise intervention produced a clinically significant improvement in the Short Physical Performance Battery and improvements in flexibility and strength, demonstrating the effectiveness of a low-cost DVD exercise program in improving physical function in older adults.

Hall, K. S., Wójcicki, T. R., Phillips, S. M., & McAuley, E. (2012). Validity of the Multidimensional Outcome Expectations for Exercise Scale in continuing-care retirement communities. Journal of Aging and Physical Activity, 20(4), 456-468.

Objective: The current study examined the psychometric properties and validity of the Multidimensional Outcome Expectations for Exercise Scale (MOEES) in a sample of older adults with physical and functional comorbidities. Methods: Confirmatory factor analysis was used to examine the hypothesized 3-factor model in 108 older adults (M age 85 yr) residing in continuing-care retirement communities. Results: Analyses supported the 3-factor structure of the MOEES reflecting physical, social, and self-evaluative outcome expectations, with a 12-item model providing the best fit. Theorized bivariate associations between outcome expectations and physical activity, self-efficacy, and functional performance were all supported. Conclusions: The 12-item version of the MOEES appears to be a reliable and valid measure of outcome expectations for exercise in this sample of older adults with physical and functional comorbidities. Further examination of the factor structure and the longitudinal properties of this measure in older adults is warranted.

Erickson, K. I., Weinstein, A. M., Sutton, B. P., Prakash, R. S., Voss, M. W., Chaddock, L., Szabo, A. N., Mailey, E. L., White, S. M., Wójcicki, T. R., McAuley, E., & Kramer, A. F. (2012). Beyond vascularization: Aerobic fitness is associated with N-acetylaspartate and working memory. Brain and Behavior, 2, 32-42.

AbstractAerobic exercise is a promising form of prevention for cognitive decline; however, little is known about the molecular mechanisms by which exercise and fitness impacts the human brain. Several studies have postulated that increased regional brain volume and function are associated with aerobic fitness because of increased vascularization rather than increased neural tissue per se. We tested this position by examining the relationship between cardiorespiratory fitness and N-acetylaspartate (NAA) levels in the right frontal cortex using magnetic resonance spectroscopy. NAA is a nervous system specific metabolite found predominantly in cell bodies of neurons. We reasoned that if aerobic fitness was predominantly influencing the vasculature of the brain, then NAA levels should not vary as a function of aerobic fitness. However, if aerobic fitness influences the number or viability of neurons, then higher aerobic fitness levels might be associated with greater concentrations of NAA. We examined NAA levels, aerobic fitness, and cognitive performance in 137 older adults without cognitive impairment. Consistent with the latter hypothesis, we found that higher aerobic fitness levels offset an age-related decline in NAA. Furthermore, NAA mediated an association between fitness and backward digit span performance, suggesting that neuronal viability as measured by NAA is important in understanding fitness-related cognitive enhancement. Since NAA is found exclusively in neural tissue, our results indicate that the effect of fitness on the human brain extends beyond vascularization; aerobic fitness is associated with neuronal viability in the frontal cortex of older adults.

McAuley, E., Wójcicki, T. R., White, S. M., Mailey, E. L., Szabo, A. N., Gothe, N., Olson, E. A., Mullen, S. P., Fanning, J. F., Motl, R. W., Rosengren, K., & Estabrooks, P. (2012). Physical activity, function, and quality of life: Design and methods of the FlexToBa™ trial. Contemporary Clinical Trials, 33, 228-236.

The Flexibility, Toning, and Balance (FlexToBa™) Trial is a two-armed randomized controlled trial which will contrast the effects of a DVD-delivered, home-based, physical activity intervention and a Healthy Aging attention control condition on physical activity, functional performance, functional limitations, and quality of life in low active, older adults. This innovative trial will recruit 300 participants across central Illinois who will be randomized into the intervention arm or control arm of the study. The intervention will last 6months with a 6month follow-up. Assessments at baseline, post intervention and follow-up will include physical activity (self-report and accelerometry), a battery of functional performance measures, functional limitations, quality of life, and an array of psychological health measures. In addition, measures of external validity will be included to determine public health significance of a successful outcome. Participants will engage in a progressive series of activities focusing on flexibility, strengthening, and balance exercises which are demonstrated by a trained exercise leader and age-appropriate models on a series of DVDs. Delivery of the intervention has its basis in social cognitive theory. The specific aims of the trial are (a) to determine the effects of the DVD-delivered FlexToBa™ program on physical activity, functional performance, functional limitations, and quality of life, (b) to examine the mediators of the relationships between physical activity and functional limitations and quality of life, (c) to assess external validity indicators relative to the intervention, and (d) to determine differential effects of the intervention on psychosocial health measures.