Publications by authors named "Bernardine M Pinto"

54 Publications

Strengthening collaborative research and scholarship in a College of Nursing.

J Prof Nurs 2021 Mar-Apr;37(2):373-378. Epub 2020 Apr 25.

University of South Carolina, United States of America.

Background: There is a need to facilitate research collaboration between PhD- and DNP-educated faculty at colleges and schools of nursing. Both types of doctoral-prepared faculty are hired, and their skills and expertise are often different yet complementary. Strengthening collaborations can contribute to new knowledge and the translation of research into practice.

Purpose: The purpose of this study was to implement four strategies to foster research and scholarship productivity and evaluate the outcomes.

Method: We implemented four strategies to foster collaboration. Two interactional strategies included Research Exchange (an annual event) and an enhanced matchmaking and mentoring plan. The two organizational strategies implemented were internal research pilot funds and writing clubs.

Results: All four approaches have been found to be effective in improving research collaboration and scholarship outcomes, including presentations, manuscripts, and proposals for external funding. Faculty have provided suggestions for further improvements.

Conclusions: National trends indicate that there may be more DNP-prepared faculty than PhD-prepared faculty hired at colleges and schools of nursing. As such, it is useful to develop and purposefully offer approaches such as the four strategies described to enhance research productivity, facilitate career progression, and contribute to improved patient outcomes.
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http://dx.doi.org/10.1016/j.profnurs.2020.04.012DOI Listing
June 2021

A 'novel' multi-component approach to promote physical activity among older cancer survivors: a pilot randomized controlled trial.

Acta Oncol 2021 Aug 10;60(8):968-975. Epub 2021 Mar 10.

Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.

Background: Physical activity (PA) provides many benefits for recovery from cancer treatments. Many older (65+ years) cancer survivors which comprise the majority of the cancer survivor population, do not meet recommended PA guidelines. This study explored the feasibility and acceptability of using audiobooks as part of a 12-week multi-component intervention to increase steps/day, light and moderate-to-vigorous intensity PA among older survivors.

Methods: Twenty older cancer survivors (95% female, mean age = 71.55 years, 90% White, 85% overweight/obese, 75% breast cancer survivors, mean 1.96 years since treatment completion) were randomized into one of the two study groups (Audiobook Group,  = 12, Comparison Group,  = 8). Both study groups were provided a tailored step goal program over the 12-week intervention; weekly step increases were based on a percent increase from baseline. Participant self-monitored their steps using a Fitbit Charge 2. In addition, the Audiobook group were encouraged to listen to audiobooks (downloaded onto a smartphone device an app available at no cost from the local library) during PA to add enjoyment and increase PA. Regression analyses on steps/day, light and moderate-to-vigorous PA/week and sedentary time/week as assessed by the Actigraph were conducted, after adjusting for Actigraph wear time. Data from the post-intervention questionnaire were summarized.

Results: Overall, majority of participants (89%) stated they were very satisfied with their participation and 100% reported that they were able to maintain their activity upon study completion. Retention rates were high. At post-intervention, there were significant differences favoring the Audiobook group for steps/day and moderate-to-vigorous PA/week. No significant group differences were found for minutes of light intensity PA/week and sedentary time/week.

Conclusion: Piloting the implementation of a sustainable, innovative intervention among older survivors to increase their PA has significance for this group of survivors.
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http://dx.doi.org/10.1080/0284186X.2021.1896032DOI Listing
August 2021

Promoting physical activity in young adult cancer survivors using mHealth and adaptive tailored feedback strategies: Design of the Improving Physical Activity after Cancer Treatment (IMPACT) randomized controlled trial.

Contemp Clin Trials 2021 04 27;103:106293. Epub 2021 Jan 27.

Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Introduction: Despite the health benefits of physical activity for cancer survivors, nearly 60% of young adult cancer survivors (YACS) are physically inactive. Few physical activity interventions have been designed specifically for YACS.

Purpose: To describe the rationale and design of the IMPACT (IMproving Physical Activity after Cancer Treatment) trial, which tests the efficacy of a theory-based, mobile physical activity intervention for YACS.

Methods: A total of 280 physically inactive YACS (diagnosed at ages 18-39) will be randomized to a self-help control or intervention condition. All participants will receive an activity tracker and companion mobile app, cellular-enabled scale, individual videochat session, and access to a Facebook group. Intervention participants will also receive a 6-month mobile intervention based on social cognitive theory, which targets improvements in behavioral capability, self-regulation, self-efficacy, and social support, and incorporates self-regulation strategies and behavior change techniques. The program includes: behavioral lessons; adaptive goal-setting in response to individuals' changing activity patterns; tailored feedback based on objective data and self-report measures; tailored text messages; and Facebook prompts encouraging peer support. Assessments occur at baseline, 3, 6, and 12 months. The primary outcome is total physical activity min/week at 6 months (assessed via accelerometry); secondary outcomes include total physical activity at 12 months, sedentary behavior, weight, and psychosocial measures.

Conclusions: IMPACT uniquely focuses on physical activity in YACS using an automated tailored mHealth program. Study findings could result in a high-reach, physical activity intervention for YACS that has potential to be adopted on a larger scale and reduce cancer-related morbidity. ClinicalTrials.gov Identifier: NCT03569605.
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http://dx.doi.org/10.1016/j.cct.2021.106293DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8089056PMC
April 2021

The many faces of recruitment in a randomized controlled trial.

Contemp Clin Trials 2021 03 19;102:106285. Epub 2021 Jan 19.

Center for Health Promotion and Health Equity, Department of Behavioral and Social Sciences, Brown University, School of Public Health, Box G-S121-8, Providence, RI 02912, USA.

Background: Thoughtful approaches to study recruitment are a critical step in designing and implementing randomized controlled trials. Delays and challenges in recruitment can be costly and can result in smaller than proposed sample sizes which have downstream effects, such as underpowered studies.

Purpose: The current study evaluated recruitment methods (e.g., targeted mailings, brochures/flyers, social media) and their relationship to eligibility, randomization, participant characteristics and retention at end of a randomized controlled trial of physical activity adoption and maintenance among breast cancer survivors.

Methods: Screening data from 874 women was analyzed for recruitment method, study eligibility, randomization and retention through end of treatment. Costs per randomized participant were calculated by recruitment method. Baseline participant characteristics were compared across recruitment methods and between randomized and retained participants.

Results: Rates of participant accrual from eligibility screening through randomization differed statistically significantly depending on recruitment method (p < .05). The highest randomization rates were obtained via targeted mailings (88.2%) and lowest via brochure/flyer (0.4%). Among the randomized sample, there were no differences in demographic characteristics between recruitment methods, however, there were differences within the targeted mailings category (registries vs. organizational recruitment). There were statistically significant differences in costs between recruitment methods (p < .001) with lowest (non-negligible) cost being targeted mailings.

Conclusions: The current RCT of breast cancer survivors successfully recruited and retained participants, highlighting the need to combine recruitment methods to achieve accrual goals. Recruitment methods differed substantially in their cost and their ability to attract individuals who would ultimately be randomized.
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http://dx.doi.org/10.1016/j.cct.2021.106285DOI Listing
March 2021

Pivoting Nursing Research and Scholarship During the COVID-19 Pandemic.

Nurs Res 2021 May-Jun 01;70(3):165-172

Background: The global COVID-19 pandemic has brought numerous challenges for conducting the human subjects research needed to advance science and improve health.

Objectives: The purpose of this article is to discuss how a college of nursing at a large public university in the southeast United States has responded to the challenges of conducting research during the novel COVID-19 pandemic.

Methods: Seven faculty researchers at the University of South Carolina College of Nursing share their experiences in overcoming the unique challenges of conducting research because of the COVID-19 pandemic. Strategies to overcome the challenges posed by COVID-19 are presented within the context of the research process, career implications, communication, and maintaining morale.

Results: Fears of COVID-19 and social distancing measures have hindered participant recruitment, enrollment, and involvement in ongoing studies. Increasing virtual technology use and enhancing safety precautions have assisted researchers to overcome barriers. Scholarly writing has increased for some faculty members whose studies have been stalled by the pandemic, yet others have seen a decline because of additional personal responsibilities. The careers of faculty members across all ranks have been uniquely affected by the pandemic. With most faculty working remotely, enhanced communication strategies at the university and college have supported the research enterprise. Morale has been adversely affected, but a variety of personal and collegial efforts have helped faculty cope and preserve a sense of normalcy during this devastating pandemic.

Discussion: Faculty and their ability to conduct the research needed to inform clinical and public health practice have been adversely affected by the COVID-19 pandemic. Despite the challenges of conducting research during this unprecedented crisis, faculty and institutions are taking novel steps to ensure the continuity of scientific progress for improving the health and well-being of patients and populations.
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http://dx.doi.org/10.1097/NNR.0000000000000493DOI Listing
April 2021

Sedentary behavior among breast cancer survivors: a longitudinal study using ecological momentary assessments.

J Cancer Surviv 2021 Aug 7;15(4):546-553. Epub 2020 Oct 7.

Brown University School of Public Health, Providence, RI, 02908, USA.

Purpose: Sedentary behavior (SB) or any waking behavior ≤ 1.5 METs is associated with an increase in body weight and fatigue and poor quality of life among cancer survivors. The purpose of this study was to explore longitudinal trends in SB using accelerometers and associated variables via ecological momentary assessments (EMA) among breast cancer survivors.

Methods: Breast cancer survivors (within 5 years post-diagnosis) were recruited for a 12-month observational study. Participants were asked to download an EMA application to their smartphones to receive prompts for 7 days and to concurrently wear an Actigraph accelerometer. Participants responded to 35 prompts during each 7-day assessment period at baseline, and at 3, 6, 9, and 12 months. Within each prompt, participants were asked questions about their current level of affect, sadness, anxiety, stress, worry and fatigue, and cancer-related symptoms (e.g., neuropathy).

Results: Twenty-two survivors (mean age = 51.5 years) were recruited and 20 participants completed the study. Mean baseline SB averaged 76.7 h/week. Univariate longitudinal models suggested higher levels of sadness, anxiety, stress, worry, and fatigue were associated with more SB while more positive affect was associated with less SB. Additionally, non-leisure context (work) was associated with more SB. Autoregressive models indicated cross-lagged effects of affective valence, fatigue, and SB.

Conclusions: More negative affective valence and higher fatigue were associated with more SB. Reducing negative affect valence and offering non-sedentary approaches to manage fatigue may help reduce SB.

Implications For Cancer Survivors: Specific interventions are needed to reduce SB among cancer survivors-particularly those that target negative affect valence and fatigue.
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http://dx.doi.org/10.1007/s11764-020-00948-xDOI Listing
August 2021

Balancing Internal and External Validity Using Precis-2 and Re-Aim: Case Exemplars.

West J Nurs Res 2021 Feb 10;43(2):163-171. Epub 2020 Jul 10.

College of Nursing, Advancing Chronic Care through Research and Innovation Center (ACORN Center), University of South Carolina, Columbia, SC, USA.

The National Institutes of Health estimated that $3-$4 billion is spent supporting clinical trials annually, yet an average of 17 years is required for research evidence to be implemented into practice. Study designs that balance external and internal validity, based on the goals of the study and relative to the state of the science, may accelerate knowledge translation. The purpose of this case study was to evaluate two randomized control trials on the effectiveness-efficacy continuum using the PRagmatic Explanatory Continuum Indicator Summary and the Research Effectiveness Adoption Implementation Maintenance model. Findings provided insight into strategies that may lead to more balanced approaches to research design. Incorporating tools such as PRECIS-2 and RE-AIM when designing and implementing research interventions may accelerate knowledge translation to close the gap between scientific knowledge and clinical practice.
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http://dx.doi.org/10.1177/0193945920940308DOI Listing
February 2021

Association of Body Esteem with Fitness and Body Fat Among Colorectal Cancer Survivors: Secondary Analyses from a Randomized Trial.

Int J Behav Med 2019 Dec;26(6):619-628

School of Public Health, Brown University, 121 S Main Street, Providence, RI, USA.

Background: Survival rates among cancer survivors have improved; however, treatments affect body esteem. Body esteem can significantly affect quality of life and depression following cancer treatment. The purpose of these secondary analyses was to examine the relationship between changes in fitness and body fat with changes in body esteem among colorectal cancer survivors who participated in a randomized controlled trial that tested the effects of a 12-week physical activity intervention.

Method: Male and female colorectal cancer survivors (< 5 years since diagnosis) participated in a randomized controlled trial that tested a 12-week moderate-intensity physical activity intervention. Body esteem, fitness (estimated VO peak), and body composition (bioelectrical impedance) were assessed at baseline and follow-up visits (3 months, 6 months, and 12 months).

Results: Forty-six colorectal cancer survivors (57 years old, 57% female) completed the study. Improvements in fitness were associated with improvements in body esteem among males at 6-month and 12-month follow-up visits, while improvements in body fat were associated with increased body esteem at 12-month follow-up among females. Improvements in fitness and body fat among stage 0-2 survivors were associated with significant improvements in body esteem, with no significant changes among stage 3 survivors.

Conclusion: Results from this study showed that improved fitness and body composition can improve body esteem among these survivors; however, differences exist among gender and disease stage.

Trial Registration: https://clinicaltrials.gov/ct2/show/NCT00230646?term=Pinto&cond=Colorectal+Cancer&rank=2.
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http://dx.doi.org/10.1007/s12529-019-09819-xDOI Listing
December 2019

Exercise is medicine in oncology: Engaging clinicians to help patients move through cancer.

CA Cancer J Clin 2019 11 16;69(6):468-484. Epub 2019 Oct 16.

Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland.

Multiple organizations around the world have issued evidence-based exercise guidance for patients with cancer and cancer survivors. Recently, the American College of Sports Medicine has updated its exercise guidance for cancer prevention as well as for the prevention and treatment of a variety of cancer health-related outcomes (eg, fatigue, anxiety, depression, function, and quality of life). Despite these guidelines, the majority of people living with and beyond cancer are not regularly physically active. Among the reasons for this is a lack of clarity on the part of those who work in oncology clinical settings of their role in assessing, advising, and referring patients to exercise. The authors propose using the American College of Sports Medicine's Exercise Is Medicine initiative to address this practice gap. The simple proposal is for clinicians to assess, advise, and refer patients to either home-based or community-based exercise or for further evaluation and intervention in outpatient rehabilitation. To do this will require care coordination with appropriate professionals as well as change in the behaviors of clinicians, patients, and those who deliver the rehabilitation and exercise programming. Behavior change is one of many challenges to enacting the proposed practice changes. Other implementation challenges include capacity for triage and referral, the need for a program registry, costs and compensation, and workforce development. In conclusion, there is a call to action for key stakeholders to create the infrastructure and cultural adaptations needed so that all people living with and beyond cancer can be as active as is possible for them.
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http://dx.doi.org/10.3322/caac.21579DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7896280PMC
November 2019

Mediators of physical activity adoption and maintenance among breast cancer survivors.

J Behav Med 2020 08 3;43(4):605-613. Epub 2019 Aug 3.

Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA.

The purpose of this study is to explore the mediators associated with physical activity (PA) within the adoption and maintenance phase of a PA intervention trial among breast cancer survivors. Overall, 192 breast cancer survivors (average age = 55.9 years) were randomized to an Intervention or Control group. Both groups received 8 calls in the first 3-months, 3 monthly calls, and then entered a no-contact maintenance phase for the remaining 6-months. Assessments were completed at baseline, 3-months, 6-months and 12-months. On average, participants were 55.9 years of age (SD = 9.8) and 2.9 years since diagnosis (SD = 2.2). In the adoption phase, all significant univariate mediators (self-efficacy, cognitive and behavioral processes and decisional balance cons) were included in the multivariate model. Results suggest self-efficacy (ab = 13.56, SE = 7.04) and behavioral processes (ab = 36.10, SE = 12.22) were significant for PA adoption. No mediators were identified in the maintenance phase. In the adoption phase, there were significant indirect effects of group on PA adoption through self-efficacy and behavioral processes. There were no indirect effects of group on PA maintenance.
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http://dx.doi.org/10.1007/s10865-019-00085-6DOI Listing
August 2020

Correlates of Moderate-to-Vigorous Physical Activity and Exercise Motivation in Underserved African American Men.

Am J Mens Health 2019 May-Jun;13(3):1557988319855155

1 University of South Carolina, College of Nursing, Columbia, SC, USA.

Effective interventions are needed to increase physical activity (PA) in African American men, but little is known about correlates of PA and exercise motivation in this population. Using an ecological approach that considers cognitive, social, and environmental factors, correlates of moderate-to-vigorous physical activity (MVPA) and exercise motivation in underserved African American men were examined. Greater exercise motivation, greater social support for exercise, and more favorable environmental perceptions were hypothesized to be associated with higher MVPA, and greater social support and environmental perceptions were hypothesized to be associated with higher exercise motivation. This secondary analysis used baseline data from the Positive Action for Today's Health (PATH) trial. African American men ( n = 166, aged 48 ± 15 years) completed surveys that assessed cognitive, social, and environmental factors theoretically relevant to MVPA. Accelerometers were used to obtain a 7-day estimate of MVPA. Hierarchical linear regression analyses showed that exercise motivation was positively associated with MVPA ( B = 1.15, SE = .41, p = .006). Exercise attitudes ( B = .16, SE = .07, p = .037), exercise self-concept ( B = .28, SE = .06, p < .001), exercise support from friends ( B = .12, SE = .06, p = .048), and places for walking and cycling ( B = .13, SE = .06, p = .032) were positively associated with exercise motivation. Interventions that improve exercise motivation and associated variables may be warranted to increase MVPA in underserved African American men. ClinicalTrials.gov # NCT01025726.
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http://dx.doi.org/10.1177/1557988319855155DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6545657PMC
July 2020

Change in physical activity and quality of life in endometrial cancer survivors receiving a physical activity intervention.

Health Qual Life Outcomes 2019 May 27;17(1):91. Epub 2019 May 27.

Center for Energy Balance, Department of Behavioral Science, MD Anderson Cancer Center, Cancer Prevention Building, Unit 1330, 1155 Pressler St, Houston, TX, 77030, USA.

Background: Endometrial cancer survivors are at an increased risk of poor quality of life outcomes. Physical activity is positively associated with general quality of life in this population, however, little is known about how changes in physical activity may be associated with changes in specific aspects of quality of life. The aim of this secondary data analysis was to explore the relationships between change in physical activity and change in physical, mental, social, and other aspects of quality of life in endometrial cancer survivors receiving a physical activity intervention.

Methods: Endometrial cancer survivors (N = 100) participated in a telephone-based physical activity intervention for six months. At baseline and post-intervention we measured physical activity via accelerometry and ecological momentary assessment, and quality of life via the Short Form Health Survey (SF-36), the Quality of Life of Adult Cancer Survivors instrument, the Brief Symptom Inventory, the Pittsburgh Sleep Quality Index, and the Perceived Stress Scale. We conducted structural equation modeling path analyses to investigate how physical activity post-intervention was associated with the quality of life measures' subscales post-intervention, adjusting for baseline levels and potentially confounding covariates.

Results: Increasing physical activity was positively associated with improvements in general health (p = .044), role limitation due to physical health (p = .005), pain (p = .041), and somatic distress (p = .023). There was no evidence to indicate that change in physical activity was associated with change in other aspects of quality of life.

Conclusions: Endometrial cancer survivors are at higher risk for suffering from challenges to physical quality of life, and findings from this study suggest that increasing physical activity may alleviate some of these problems. Further research is needed to determine whether other aspects of quality of life are linked to change in physical activity.

Trial Registration: Trial registration number: NCT00501761 Name of registry: clinicaltrials.gov Date of registration: July 16, 2007. Date of enrollment: June 16, 2005.
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http://dx.doi.org/10.1186/s12955-019-1154-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6537149PMC
May 2019

Systematic review and meta-analysis of maintenance of physical activity behaviour change in cancer survivors.

Int J Behav Nutr Phys Act 2019 04 27;16(1):37. Epub 2019 Apr 27.

School of Health Sciences, University of Southampton, Southampton, UK.

Background: Physical activity can improve health and wellbeing after cancer and may reduce cancer recurrence and mortality. To achieve such long-term benefits cancer survivors must be habitually active. This review evaluates the effectiveness of interventions in supporting maintenance of physical activity behaviour change among adults diagnosed with cancer and explores which intervention components and contextual features are associated with effectiveness.

Methods: Relevant randomised controlled trials (RCTs) were identified by a search of Ovid Medline, Ovid Embase and PsychINFO. Trials including adults diagnosed with cancer, assessed an intervention targeting physical activity and reported physical activity behaviour at baseline and ≥ 3 months post-intervention were included. The behaviour change technique (BCT) taxonomy was used to identify intervention components and the Template for Intervention Description and Replication to capture contextual features. Random effect meta-analysis explored between and within group differences in physical activity behaviour. Standardised mean differences (SMD) describe effect size.

Results: Twenty seven RCTs were included, 19 were pooled in meta-analyses. Interventions were effective at changing long-term behaviour; SMD in moderate to vigorous physical activity (MVPA) between groups 0.25; 95% CI = 0.16-0.35. Within-group pre-post intervention analysis yielded a mean increase of 27.48 (95% CI = 11.48-43.49) mins/wk. of MVPA in control groups and 65.30 (95% CI = 45.59-85.01) mins/wk. of MVPA in intervention groups. Ineffective interventions tended to include older populations with existing physical limitations, had fewer contacts with participants, were less likely to include a supervised element or the BCTs of 'action planning', 'graded tasks' and 'social support (unspecified)'. Included studies were biased towards inclusion of younger, female, well-educated and white populations who were already engaging in some physical activity.

Conclusions: Existing interventions are effective in achieving modest increases in physical activity at least 3 months post-intervention completion. Small improvements were also evident in control groups suggesting low-intensity interventions may be sufficient in promoting small changes in behaviour that last beyond intervention completion. However, study samples are not representative of typical cancer populations. Interventions should consider a stepped-care approach, providing more intensive support for older people with physical limitations and others less likely to engage in these interventions.
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http://dx.doi.org/10.1186/s12966-019-0787-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6486962PMC
April 2019

Rebuilding the research enterprise of a historical research intensive college of nursing.

Nurs Outlook 2019 May - Jun;67(3):232-243. Epub 2019 Jan 20.

University of South Carolina, College of Nursing, Columbia, SC.

Background: Maintaining a productive research enterprise within a college of nursing is multifaceted and complex. It is especially challenging when a college's mission transitions to address other priorities, and later attempts to re-emerge in the competitive funding environment and re-establish a productive research portfolio.

Purpose: To describe how a college is rebuilding the research enterprise to meet the established research mission after a decade of marginal research productivity.

Strategies: Targeted multi-level strategies at the university, college, and individual levels are being implemented to enhance the research infrastructure and faculty capacity to increase research productivity.

Impact: In the past five years, compared to the previous five years, annual faculty publications have doubled, annual extramural funding per tenure track faculty increased by 72%, and the College's average extramural sponsored award funding per year increased 118%. National Institutes for Research rankings moved from no ranking (2013) to top 31 (2017).

Discussion: Early results are positive and efforts to maintain and further grow the research enterprise will require sustained effort to meet ongoing challenges.
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http://dx.doi.org/10.1016/j.outlook.2019.01.002DOI Listing
October 2019

Predictors of sedentary behavior among colorectal survivors.

Support Care Cancer 2019 Jun 16;27(6):2049-2056. Epub 2018 Sep 16.

The Miriam Hospital & School of Public Health, Brown University, 22 Richmond Street, Providence, RI, 02906, USA.

Purpose: Colorectal cancer (CRC) survivors spend approximately 9 h per day in sedentary behavior (SED), despite recommendations to reduce sitting time. The purpose of this study was to examine predictors of SED among CRC survivors over a 1-year duration.

Methods: Male and female CRC survivors (< 5 years since diagnosis) participated in a 12-week moderate-to-vigorous physical activity randomized controlled trial. To measure SED, participants were given a CSA monitor to wear for three consecutive days (including one weekend day). Additionally, fitness (Treadmill walk test), body composition (bioelectrical impedance analysis) and questionnaires (Profile of Mood States, Exercise Processes of Change and Self-Efficacy for Exercise) were administered. Follow-up assessments were completed at a 3-month, 6-month, and 12-month follow-up.

Results: Forty-six colorectal survivors (average age = 57.3 ± 9.7 years) completed the 12-month study. Using latent class models, four classes of SED behavior over time were identified: class 1 (high and sustained SED over time), class 2 (low and sustain SED over time), class 3 (increasing SED over time), and class 4 (high SED through 6-months, followed be a marked decrease at 12-months). Males were more likely to be in class 1, while majority of females were in class 3. Those CRC survivors with a better mood at baseline were in class 2, while those with poor fitness, high body fat, and higher cognitive processes at baseline were in class 3.

Conclusion: Identifying the characteristics of survivors who engage in high SED can help healthcare providers to target their efforts to reduce SED.
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http://dx.doi.org/10.1007/s00520-018-4452-2DOI Listing
June 2019

Bridging the Gap: Racial concordance as a strategy to increase African American participation in breast cancer research.

J Health Psychol 2019 09 27;24(11):1548-1561. Epub 2017 Nov 27.

1 Rowan University, USA.

Lack of African American females in breast cancer research has been receiving substantial attention. This study seeks to identify research perceptions and motivating factors needed to increase racial/ethnic minority participation in breast cancer research. A total of 57 African American women (Σ = 47.8 years), from Rhode Island and Texas, completed a questionnaire and focus group. While many participants were not breast cancer survivors, they reported knowledge of their racial group's risk for breast cancer. One major finding that could be seen as both a facilitator and barrier is racial concordance between participant and researcher. Cultural sensitivity and trust building is recommended to increase minority participation.
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http://dx.doi.org/10.1177/1359105317740736DOI Listing
September 2019

Weight management and physical activity throughout the cancer care continuum.

CA Cancer J Clin 2018 01 22;68(1):64-89. Epub 2017 Nov 22.

Chief Medical Advisor, Bipartisan Policy Center, Washington, DC.

Mounting evidence suggests that weight management and physical activity (PA) improve overall health and well being, and reduce the risk of morbidity and mortality among cancer survivors. Although many opportunities exist to include weight management and PA in routine cancer care, several barriers remain. This review summarizes key topics addressed in a recent National Academies of Science, Engineering, and Medicine workshop entitled, "Incorporating Weight Management and Physical Activity Throughout the Cancer Care Continuum." Discussions related to body weight and PA among cancer survivors included: 1) current knowledge and gaps related to health outcomes; 2) effective intervention approaches; 3) addressing the needs of diverse populations of cancer survivors; 4) opportunities and challenges of workforce, care coordination, and technologies for program implementation; 5) models of care; and 6) program coverage. While more discoveries are still needed for the provision of optimal weight-management and PA programs for cancer survivors, obesity and inactivity currently jeopardize their overall health and quality of life. Actionable future directions are presented for research; practice and policy changes required to assure the availability of effective, affordable, and feasible weight management; and PA services for all cancer survivors as a part of their routine cancer care. CA Cancer J Clin 2018;68:64-89. © 2017 American Cancer Society.
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http://dx.doi.org/10.3322/caac.21441DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5766382PMC
January 2018

Guideposts for Physical Activity, Diet, and Weight Management Interventions Among Cancer Survivors.

Obesity (Silver Spring) 2017 11;25 Suppl 2:S23-S24

Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona Cancer Center, University of Arizona, Tucson, Arizona, USA.

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http://dx.doi.org/10.1002/oby.22017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5784764PMC
November 2017

Agenda for Translating Physical Activity, Nutrition, and Weight Management Interventions for Cancer Survivors into Clinical and Community Practice.

Obesity (Silver Spring) 2017 11;25 Suppl 2:S9-S22

Department of Nutrition Sciences, University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, Alabama, USA.

Evidence supporting physical activity, diet, and weight management for cancer survivors has grown, leading to the development of guidelines and interventions. The next step is to identify necessary practice and policy changes and to develop a research agenda to inform how interventions can be delivered to survivors most effectively and efficiently in health care settings and by community-based organizations. Here, an agenda is proposed for research, practice, and policy that incorporates recommendations for a range of programming options, a patient-centered, tailored screening and referral approach, and training needs for survivorship care providers and providers of exercise, nutrition, and weight management services. Research needs to focus on sustainability, dissemination, and implementation. Needed policy changes are presented, as well as opportunities to leverage current health care policies.
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http://dx.doi.org/10.1002/oby.22031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5683412PMC
November 2017

Peer mentors delivering a physical activity intervention for cancer survivors: effects among mentors.

Transl Behav Med 2017 12;7(4):680-689

Rollins School of Public Health, Emory University, Atlanta, GA, USA.

To further inform implementation efforts of a telephone-based physical activity (PA) intervention for breast cancer survivors, we assessed the PA, fatigue, mood, and quality of life of the peer mentors/coaches who delivered the program. The coaches were volunteers with the American Cancer Society's Reach to Recovery program. The coaches (n = 18) delivered the PA intervention to 76 breast cancer survivors in a randomized controlled trial. Coaches completed assessments of PA (self-report), motivational readiness for PA, and standardized measures of psychosocial variables at the start of coaching and at study exit. At study exit, they also responded to an open-ended question on the benefits that they accrued from the study. We used generalized linear models to analyze the PA data and psychosocial variables. Chi-squared analyses were used for motivational readiness. The written responses to the open-ended question were analyzed to identify themes. Coaches' PA exceeded national recommendations at study entry and exit with no significant changes over time. Sixty-one percent were in the maintenance stage of motivational readiness, and 61% remained in the same stage at study exit. Psychosocial functioning also remained stable over time. Qualitative data revealed that the coaches' gains included helping themselves (with four subthemes) and helping others. Intervention delivery had no unintended negative consequences (PA, motivational readiness, and psychosocial functioning) among coaches. They reported gains that were not reflected in standardized psychosocial assessments. These data support further implementation of peer-delivered PA programs to enhance the reach of interventions.
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http://dx.doi.org/10.1007/s13142-016-0460-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5684062PMC
December 2017

Accelerometer determined lifestyle behaviors over time-letter.

Cancer Epidemiol Biomarkers Prev 2014 Nov;23(11):2612

National Institute of Nursing Research, NIH/DHHS, Bethesda, Maryland.

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http://dx.doi.org/10.1158/1055-9965.EPI-14-0916DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4221801PMC
November 2014

Peers promoting physical activity among breast cancer survivors: A randomized controlled trial.

Health Psychol 2015 May 11;34(5):463-72. Epub 2014 Aug 11.

Centers for Behavioral and Preventive Medicine, The Miriam Hospital.

Objective: Although studies have shown that physical activity (PA) can reduce some treatment-related side effects of breast cancer, there is a need to offer PA programs outside of research settings to reach more cancer survivors. We partnered with the American Cancer Society's Reach to Recovery (RTR) program to train their volunteers (breast cancer survivors) to deliver a 12-week PA intervention to other breast cancer survivors.

Method: We conducted a randomized controlled trial to compare the PA intervention delivered by RTR volunteers (PA plus RTR) with contact control (RTR control). Eighteen RTR volunteers/coaches (Mage = 54.9 years; Mtime since diagnosis = 7.0 years) delivered the contact control condition or the PA intervention. Seventy-six breast cancer survivors in New England (Mage = 55.6 years; Mtime since diagnosis = 1.1 years) were randomized to 1 of the 2 groups. At baseline, 12 weeks (postintervention), and at 24 weeks, participants wore an accelerometer for 7 days, were interviewed about their PA, and reported their motivational readiness for PA.

Results: Adjusted, mixed-effects longitudinal regression models showed significant group differences favoring the PA plus RTR group in minutes of moderate to vigorous PA at 12 weeks (Mdifference = 103 min/week, p < .001) and at 24 weeks (Mdifference = 34.7 min/week, p = .03). Results were corroborated with significant group differences in accelerometer data favoring the PA plus RTR group at both time points.

Conclusion: Peer volunteers were able to significantly increase PA among cancer survivors relative to contact control. Partnerships with existing volunteer programs can help to widen the reach of behavioral interventions among cancer survivors. (PsycINFO Database Record
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http://dx.doi.org/10.1037/hea0000120DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4441331PMC
May 2015

Mediators of exercise maintenance after cardiac rehabilitation.

J Cardiopulm Rehabil Prev 2015 Jan-Feb;35(1):13-20

Centers for Behavioral and Preventive Medicine, The Miriam Hospital and W. Alpert Medical School of Brown University, Providence, Rhode Island.

Purpose: Exercise maintenance after completing phase II cardiac rehabilitation (CR) is challenging for many patients. A telephone-based maintenance intervention improved exercise participation compared with a control group at 12 months post-CR discharge. We examined the 6-month mediators of intervention effects on exercise.

Methods: In a randomized controlled trial, 130 patients who had completed CR (mean age: 63.6 [SD = 9.7] years, 20.8% female) were randomized to Maintenance Counseling (n = 64) or Contact Control (n = 66). Putative mediators examined the following: self-efficacy, behavioral processes of change, decisional balance index, social support for exercise, and enjoyment of exercise.

Results: Multiple mediation analyses showed that the intervention significantly increased social support from friends at 6 months but not the other constructs. Decreasing support from friends mediated greater exercise participation in Maintenance Counseling than in Contact Control at 12 months.

Conclusions: Social support from friends functioned as a suppressor mediator for exercise maintenance among cardiac patients.
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http://dx.doi.org/10.1097/HCR.0000000000000065DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4276523PMC
July 2015

A community-based partnership to promote exercise among cancer survivors: lessons learned.

Int J Behav Med 2015 Jun;22(3):328-35

The Miriam Hospital, Coro West, 3rd Floor, Suite 309, 164 Summit Ave, Providence, RI, 02906, USA,

Purpose: We conducted a randomized controlled trial in partnership with a community-based organization (CBO) to examine the effects of peer mentoring to promote exercise among cancer survivors. At the end of the trial, to prepare for future program implementation on a larger scale, we obtained input from the CBO on the key elements that influenced the decision to collaborate, facilitators and challenges during the trial, and recommendations for program marketing.

Methods: Structured telephone interviews were conducted with ten stakeholders at various job levels within the CBO. Notes of the interviews were coded, and themes were extracted independently by two study members.

Results: Five themes were identified: costs of the partnership, its benefits, importance of communication, match of the trial goals with the CBO's mission, and achieving a balance between research and job tasks. Techniques to address these themes and improve implementation of the program are described.

Conclusions: The themes identified can guide evidence-based programs in planning implementation that involves partnerships with CBOs.
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http://dx.doi.org/10.1007/s12529-014-9395-5DOI Listing
June 2015

Smoking related cancers: a brief report on problem solving, distress, and risk behaviors in patients and caregivers.

J Psychosoc Oncol 2014 ;32(2):224-33

a Department of Applied Psychology , Bryant University , Smithfield , RI , USA.

Cancer diagnoses may adversely affect emotional functioning in patients and their caregivers, which in turn may increase risk behaviors, such as tobacco and alcohol use. This study investigates the relationships among problem-solving ability, distress, and risk behaviors in patients with head/neck and lung cancer and their caregivers. The authors hypothesized that patients and caregivers who experienced higher distress would engage in more risk behaviors, but that Social Problem-Solving (SPS) would moderate this effect, in that those who possessed greater SPS ability would engage in fewer risk behaviors. Twenty-one cancer patients and 11 of their caregivers were surveyed shortly after diagnosis. Participants completed the Profile of Mood States, the Social Problem-Solving Inventory-Revised, and measures of tobacco and alcohol use. Total SPS ability was higher in patients than caregivers but generally low in both groups. Total distress was lower in patients compared to caregivers. Mean comparisons indicated that caregivers smoked more cigarettes per day and consumed more alcohol than patients. Results indicate that patients and caregivers may have a decreased ability to solve problems, and that caregivers engage in more frequent risk behaviors than patients, suggesting that caregivers may be at risk and warrant further study. The study design prevents causative conclusions and limited sample size prohibits more complex analyses. Further research on social problem-solving ability, distress, and risk behaviors may reveal more robust relationships and provide insight for intervention development for these groups.
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http://dx.doi.org/10.1080/07347332.2013.874003DOI Listing
May 2014

A randomized trial to promote physical activity among breast cancer patients.

Health Psychol 2013 Jun;32(6):616-26

Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island 02903, USA.

Objective: Physical activity (PA) has been shown to provide health benefits for breast cancer patients. The effects of augmenting oncology health care provider (HCP) advice for PA with 3 months of telephone counseling versus contact control were evaluated in a randomized trial.

Methods: After receiving brief HCP advice to become physically active, 192 women (age in years: M = 60.0, SD = 9.9) who had completed treatment for Stage 0-IV breast cancer were randomized to telephone counseling to support PA (n = 106) or contact control (n = 86). Their PA, motivational readiness, fatigue, and physical functioning were assessed at baseline (before receiving HCP advice), 3, 6, and 12 months.

Results: Telephone counseling produced significant effects on the primary outcome of moderate-intensity PA of about 30 min/week at both 3 months (95% CI = 0.44, 57.32) and 6 months (95% CI = 3.06, 61.26). Intervention participants were also more than twice as likely as control participants to report improvements in achieving PA guidelines of at least 150 min/week at 3 (OR = 2.43, 95% CI = 1.18, 4.98) and 6 months (OR = 2.11, 95% CI = 1.00-4.48). Telephone counseling was significantly more effective than contact control in increasing motivational readiness for PA at all follow-ups (ORs = 3.93-6.28, all ps <.003). No between-groups differences were found for fatigue, while differential improvements in physical functioning did not remain significant past 3 months (p = .01).

Conclusion: HCP advice plus telephone counseling improved PA among breast cancer patients at 3 and 6 months and also differentially improved patients' motivational readiness at all follow-ups, suggesting the potential for exercise promotion in cancer follow-up care.
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http://dx.doi.org/10.1037/a0029886DOI Listing
June 2013

Proactive versus reactive recruitment to a physical activity intervention for breast cancer survivors: does it matter?

Clin Trials 2013 Aug 20;10(4):587-92. Epub 2013 Mar 20.

Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI 02906, USA.

Background: There is a gap in the current breast cancer survivorship literature identifying potential sample biases that may result from recruiting participants via different methods.

Purpose: To document whether participant recruitment method influences baseline demographic or psychosocial variables and trial participation among breast cancer survivors recruited for a physical activity intervention trial.

Methods: Participants were recruited for the trial via either a reactive method (letters mailed through their oncologist's office inviting them to contact the research staff) or a proactive method (referred in person by their oncologist at a clinic appointment). The groups of participants recruited via the two methods were compared based on baseline sociodemographic characteristics, weight, time since diagnosis, stage of disease, treatment, motivational readiness for physical activity, level of physical activity, self-reported physical and mental health, willingness to receive the intervention, and study retention.

Results: Participants recruited proactively were closer to the point of diagnosis (mean = 2.5 years, standard deviation (SD) = 1.9 years) than participants recruited reactively via letter mailings (mean = 3.4 years, SD = 2.3 years; p < .05). The two groups were similar with respect to all other baseline characteristics and retention.

Limitations: Recruitment via the two methods was not concurrent. Also, proactive recruitment occurred at a single hospital site. Mailings were made by the oncologists; we are unable to estimate how many letters were mailed. Similarly, we have no information for the patients who were not referred to the study during proactive recruitment.

Conclusions: Despite the potential for differences in characteristics and degree of trial participation between trial participants recruited proactively and reactively, in this investigation, the two groups were similar. Information from other trials in other conditions may confirm or modify our conclusion.
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http://dx.doi.org/10.1177/1740774513480004DOI Listing
August 2013

Physical activity and psychosocial benefits among breast cancer patients.

Psychooncology 2013 Oct 15;22(10):2193-9. Epub 2013 Mar 15.

The Miriam Hospital, Providence, RI, USA.

Objective: Physical activity (PA) has been shown to provide health benefits for breast cancer patients. The effects of augmenting oncology healthcare provider (HCP) advice for PA with 3 months of telephone counseling versus contact control were evaluated in a randomized trial. Our goal in this secondary analysis was to examine the amount of PA (min/week) needed for psychosocial benefits among both groups.

Methods: After receiving brief HCP advice to become physically active, 192 women (age in years: mean = 60.0, SD = 9.9) who had completed treatment for Stage 0-IV breast cancer were randomized to telephone counseling to support PA (n = 106) or contact control (n = 86). Their PA, fatigue, physical functioning, and quality of life were assessed at baseline (before receiving HCP advice), 3, 6, and 12 months. A non-randomized design was used to examine the dose-response relationship between PA and psychosocial outcomes.

Results: Exercising for at least 150 min/week at moderate intensity was associated with improved physical functioning (b = 5.9, SE = 2.9, p = 0.04) and quality of life (b = 3.6, SE = 1.9, p = 0.05) at 3 months. These relationships were not found at 6 and 12 months (p's > 0.05). However, women who reported at least 150 min/week of PA at both 3 and 6 months had significantly reduced fatigue (b = 1.3, SE = 0.7, p = 0.05) and improved physical functioning (b = 3.1, SE = 1.3, p = 0.02) and quality of life (b = 2.0, SE = 0.9, p = 0.02) compared with women who did not meet this criterion.

Conclusion: Women who exercised at recommended levels (at least 150 min/week) and sustained this level of activity for at least 6 months accrued psychosocial benefits.
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http://dx.doi.org/10.1002/pon.3272DOI Listing
October 2013

Psychosocial outcomes of an exercise maintenance intervention after phase II cardiac rehabilitation.

J Cardiopulm Rehabil Prev 2013 Mar-Apr;33(2):91-8

Centers for Behavioral and Preventive Medicine, Miriam Hospital, Providence, RI 02903, USA.

Purpose: Maintenance of exercise after completing phase II cardiac rehabilitation (CR) is challenging for many patients. We offered a telephone-based maintenance intervention and found improvement in exercise participation in the intervention group at 12 months post-CR discharge. We examined the effects of the intervention on psychosocial outcomes.

Methods: The effects of a home-based exercise maintenance intervention on psychosocial outcomes among patients who had completed phase II CR versus contact control were evaluated in a randomized controlled trial. Data were collected in 2005 to 2010 and analyzed in 2011. One hundred thirty patients (mean age = 63.6 [SD = 9.7] years, 20.8% female) were randomized to exercise counseling (Maintenance Counseling group, n = 64) or contact control (Contact Control group, n = 66). Maintenance Counseling group participants received exercise counseling (based on the transtheoretical model and social-cognitive theory) delivered via telephone for 6 months, as well as print materials and feedback reports. Assessments of depression, quality of life, and mental health were conducted at baseline, 6 months, and 12 months.

Results: The Maintenance Counseling group reported statistically significant higher quality of life than the Contact Control group at 6 months (b = 0.29, SE = 0.08, P < .001) and 12 months (b = 0.27, SE = 0.09, P = .002). Intervention effects on depressive symptoms were significant at 12 months (b = -6.42, SE = 2.43, P = .009). Effects on overall mental health were nonsignificant at both followups. No significant moderators of treatment effects were found.

Conclusion: A telephone-based intervention that helped maintain exercise showed statistically significant improvements in quality of life and reduced depressive symptoms in this patient population.
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http://dx.doi.org/10.1097/HCR.0b013e3182825531DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3586302PMC
August 2013

Home-based physical activity intervention for colorectal cancer survivors.

Psychooncology 2013 Jan 9;22(1):54-64. Epub 2011 Sep 9.

Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI 02903, USA.

Background: The efficacy of a home-based physical activity (PA) intervention for colorectal cancer patients versus contact control was evaluated in a randomized controlled trial.

Methods: Forty-six patients (mean age = 57.3 years [SD = 9.7], 57% female, mean = 2.99 years post-diagnosis [SD = 1.64]) who had completed treatment for stages 1-3 colorectal cancer were randomized to telephone counseling to support PA (PA group, n = 20) or contact control (control group, n = 26). PA group participants received 3 months of PA counseling (based on the transtheoretical model and the social cognitive theory) delivered via telephone, as well as weekly PA tip sheets. Assessments of PA (Seven-day Physical Activity Recall [7-day PAR] and Community Healthy Activities Model Program for Seniors [CHAMPS]), submaximal aerobic fitness (Treadwalk test), motivational readiness for PA, and psychosocial outcomes were conducted at baseline, 3, 6, and 12 months post-baseline. Objective accelerometer data were collected at the same time points.

Results: The PA group reported significant increases in minutes of PA at 3 months (7-day PAR) and caloric expenditure (CHAMPS) compared with the control group, but the group differences were attenuated over time. The PA group showed significant improvements in fitness at 3, 6, and 12 months versus the control group. Improvements in motivational readiness for PA were reported in the PA group only at 3 months. No significant group differences were found for fatigue, self-reported physical functioning, and quality of life at 3, 6, and 12 months.

Conclusion: A home-based intervention improved survivors' PA and motivational readiness at 3 months and increased submaximal aerobic fitness at 3, 6, and 12 months.
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http://dx.doi.org/10.1002/pon.2047DOI Listing
January 2013