Maria C. Swartz

Fit4Life: A weight loss intervention for children who have survived childhood leukemia

Children surviving acute lymphoblastic leukemia (ALL) are at increased risk for overweight and obesity over that of the general population. Whether a generic or tailored approach to weight management is needed for cancer survivors has yet to be tested.

What's the Point?: A Review of Reward Systems Implemented in Gamification Interventions

Rewards are commonly used in interventions to change behavior, but they can inhibit development of intrinsic motivation, which is associated with long-term behavior maintenance. Gamification is a novel intervention strategy that may target intrinsic motivation through fun and enjoyment. Before the effects of gamified interventions on motivation can be determined, there must be an understanding of how gamified interventions operationalize rewards, such as point systems. The purpose of this review is to determine the prevalence of different reward types, specifically point systems, within gamified interventions. Electronic databases were searched for relevant articles. Data sources included Medline OVID, Medline PubMed, Web of Science, CINAHL, Cochrane Central, and PsycINFO. Out of the 21 articles retrieved, 18 studies described a reward system and were included in this review. Gamified interventions were designed to target a myriad of clinical outcomes across diverse populations. Rewards included points (n = 14), achievements/badges/medals (n = 7), tangible rewards (n = 7), currency (n = 4), other unspecified rewards (n = 3), likes (n = 2), animated feedback (n = 1), and kudos (n = 1). Rewards, and points in particular, appear to be a foundational component of gamified interventions. Despite their prevalence, authors seldom described the use of noncontingent rewards or how the rewards interacted with other game features. The reward systems relying on tangible rewards and currency may have been limited by inhibited intrinsic motivation. As gamification proliferates, future research should explicitly describe how rewards were operationalized in the intervention and evaluate the effects of gamified rewards on motivation across populations and research outcomes.

Recommendations for the Optimal Design of Exergame Interventions for Persons with Disabilities: Challenges, Best Practices, and Future Research

A group discussion of individuals with expertise working in the field of exergaming and rehabilitation focused on the issue of designing exergames for persons with disabilities as well as appropriate interventions using exergames. The purpose of these discussions was to develop recommendations for the design, evaluation, and application of exergames in therapy serving as potential guidelines for researchers, developers, and therapists. The following key issues were addressed: (1) Challenges in exergame design for persons with disabilities, (2) adaptation of exergames for persons with disabilities, (3) exergame interventions, and (4) future research directions. It is the hope of the group that the results of these recommendations will help improve the quality of exergame design and interventions and thereby increase opportunities for persons with disabilities to engage sustainably in exergaming.

Testing the effects of narrative and play on physical activity among breast cancer survivors using mobile apps: study protocol for a randomized controlled trial

BackgroundPhysical activity reduces risk for numerous negative health outcomes, but postmenopausal breast cancer survivors do not reach recommended levels. Many interventions encourage self-monitoring of steps, which can increase physical activity in the short term. However, these interventions appear insufficient to increase motivation for sustained change. There is a need for innovative strategies to increase physical activity motivation in this population. Narratives are uniquely persuasive, and video games show promise for increasing motivation. This study will determine the effectiveness of an intervention that combines narrative and gaming to encourage sustained physical activity.Methods/DesignSMARTGOAL (Self-Monitoring Activity: a Randomized Trial of Game-Oriented AppLications) is a randomized controlled intervention trial. The intervention period is six months, followed by a six month maintenance period. Participants (overweight, sedentary postmenopausal breast cancer survivors aged 45–75) will be randomized to a self-monitoring group or an enhanced narrative game group. The self-monitoring group will be encouraged to use a mobile application for self-monitoring and feedback and will receive 15 counseling phone calls emphasizing self-regulation. The narrative game group will be encouraged to use a mobile application that includes self-monitoring and feedback as well as a narrative-based active video game. The 15 calls for this group will emphasize concepts related to the game storyline. Counseling calls in both groups will occur weekly in months 1 – 3 and monthly in months 4 – 6. No counseling calls will occur after month 6, but both groups will be encouraged to continue using their apps. The primary outcome of the study is minutes of moderate to vigorous physical activity at six months. Other objectively measured outcomes include fitness and physical function. Self-reported outcomes include quality of life, depression, and motivation.DiscussionThis protocol will result in implementation and evaluation of two technology-based physical activity interventions among breast cancer survivors. Both interventions hold promise for broad dissemination. Understanding the potential benefit of adding narrative and game elements to interventions will provide critical information to interventionists, researchers, clinicians, and policymakers. This study is uniquely suited to investigate not just whether but how and why game elements may improve breast cancer survivors’ health.Trial registrationclinicaltrials.gov NCT02341235 (January 9, 2015)

Mobile Health Physical Activity Intervention Preferences in Cancer Survivors: A Qualitative Study

Background Cancer survivors are at an elevated risk for several negative health outcomes, but physical activity (PA) can decrease those risks. Unfortunately, adherence to PA recommendations among survivors is low. Fitness mobile apps have been shown to facilitate the adoption of PA in the general population, but there are limited apps specifically designed for cancer survivors. This population has unique needs and barriers to PA, and most existing PA apps do not address these issues. Moreover, incorporating user preferences has been identified as an important priority for technology-based PA interventions, but at present there is limited literature that serves to establish these preferences in cancer survivors. This is especially problematic given the high cost of app development and because the majority of downloaded apps fail to engage users over the long term. Objective The aim of this study was to take a qualitative approach to provide practical insight regarding this population’s preferences for the features and messages of an app to increase PA. Methods A total of 35 cancer survivors each attended 2 focus groups; a moderator presented slide shows on potential app features and messages and asked open-ended questions to elicit participant preferences. All sessions were audio recorded and transcribed verbatim. Three reviewers independently conducted thematic content analysis on all transcripts, then organized and consolidated findings to identify salient themes. Results Participants (mean age 63.7, SD 10.8, years) were mostly female (24/35, 69%) and mostly white (25/35, 71%). Participants generally had access to technology and were receptive to engaging with an app to increase PA. Themes identified included preferences for (1) a casual, concise, and positive tone, (2) tools for personal goal attainment, (3) a prescription for PA, and (4) an experience that is tailored to the user. Participants reported wanting extensive background data collection with low data entry burden and to have a trustworthy source translate their personal data into individualized PA recommendations. They expressed a desire for app functions that could facilitate goal achievement and articulated a preference for a more private social experience. Finally, results indicated that PA goals might be best established in the context of personally held priorities and values. Conclusions Many of the desired features identified are compatible with both empirically supported methods of behavior change and the relative strengths of an app as a delivery vehicle for behavioral intervention. Participating cancer survivors’ preferences contrasted with many current standard practices for mobile app development, including value-based rather than numeric goals, private socialization in small groups rather than sharing with broader social networks, and interpretation of PA data rather than merely providing numerical data. Taken together, these insights may help increase the acceptability of theory-based mHealth PA interventions in cancer survivors.

Parental involvement in exercise and diet interventions for childhood cancer survivors: a systematic review

Childhood cancer survivors (CCS) are at risk of becoming overweight or obese due to treatment effects and/or post-treatment behaviors. Parents are key agents influencing child diet and physical activity (PA), which are modifiable risk factors for obesity. A systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was undertaken to evaluate current interventions that include diet and PA elements for CCS to determine if and to what extent parents were included, and whether parent involvement had a significant effect on behavioral outcomes or adiposity. A total of 2,386 potential articles were reviewed and 25 individual studies fulfilled inclusion criteria. Parental involvement was classified into three categories and varied across studies, although most had indirect or no parental involvement. The studies that included direct parental involvement showed positive outcomes on a variety of measures suggesting that increasing parental involvement in interventions for CCS may be one way to promote long-term lifestyle changes for pediatric cancer patients. However, additional research directly addressing parental involvement in obesity prevention and treatment among CCS is warranted.

Effect of Home- and Community-Based Physical Activity Interventions on Physical Function Among Cancer Survivors: A Systematic Review and Meta-Analysis

OBJECTIVE To examine the effect of home- and community-based physical activity interventions on physical functioning among cancer survivors based on the most prevalent physical function measures, randomized trials were reviewed. DATA SOURCES Five electronic databases-Medline Ovid, PubMed, CINAHL, Web of Science, and PsycINFO-were searched from inception to March 2016 for relevant articles. STUDY SELECTION Search terms included community-based interventions, physical functioning, and cancer survivors. A reference librarian trained in systematic reviews conducted the final search. DATA EXTRACTION Four reviewers evaluated eligibility and 2 reviewers evaluated methodological quality. Data were abstracted from studies that used the most prevalent physical function measurement tools-Medical Outcomes Study 36-Item Short-Form Health Survey, Late-Life Function and Disability Instrument, European Organisation for the Research and Treatment of Cancer Quality-of-Life Questionnaire, and 6-minute walk test. Random- or fixed-effects models were conducted to obtain overall effect size per physical function measure. DATA SYNTHESIS Fourteen studies met inclusion criteria and were used to compute standardized mean differences using the inverse variance statistical method. The median sample size was 83 participants. Most of the studies (n=7) were conducted among breast cancer survivors. The interventions produced short-term positive effects on physical functioning, with overall effect sizes ranging from small (.17; 95% confidence interval [CI], .07-.27) to medium (.45; 95% CI, .23-.67). Community-based interventions that met in groups and used behavioral change strategies produced the largest effect sizes. CONCLUSIONS Home and community-based physical activity interventions may be a potential tool to combat functional deterioration among aging cancer survivors. More studies are needed among other cancer types using clinically relevant objective functional measures (eg, gait speed) to accelerate translation into the community and clinical practice.

Exploring parental factors related to weight management in survivors of childhood central nervous system tumors.

Childhood central nervous system tumor survivors (CCNSTS) are at risk for adverse health issues. Little research has been conducted to explore the role of parental factors in weight management to mitigate adverse health outcomes. We conducted 9 group interviews (n = 20) with CCNSTS, their parents, and health care providers to ascertain parental factors that may influence weight management practices in CCNSTS. Three main themes were identified: parenting style, parent–child connectedness, and food and physical activity (PA) environment. Although most parents adopted an authoritative parenting style related to diet and PA practices, some adopted a permissive parenting style. Participants expressed high levels of connection that may hinder the development of peer relationships and described the food and PA environments that promote or hinder weight management through parental modeling of healthy eating and PA and access to healthy food and activities. Weight management interventions for CCNSTS may experience greater benefit from using a family-focused approach, promoting positive food and PA environments, parental modeling of healthy eating and exercise, and partnering with youth to adopt weight management behaviors.

A randomized nutrition counseling intervention in pediatric leukemia patients receiving steroids results in reduced caloric intake

Quality of life in survivors of pediatric acute lymphocytic leukemia (ALL) can be compromised by chronic diseases including increased risk of second cancers, cardiovascular disease, and diabetes. Overweight or obesity further increases these risks. Steroids are a component of chemotherapy for ALL, and weight gain is a common side effect. To impact behaviors associated with weight gain, we conducted a randomized nutrition counseling intervention in ALL patients on treatment.

Know Your Value: Negotiation Skill Development for Junior Investigators in the Academic Environment—A Report from the American Society of Preventive Oncology's Junior Members Interest Group

The American Society of Preventive Oncology (ASPO) is a professional society for multidisciplinary investigators in cancer prevention and control. One of the aims of ASPO is to enable investigators at all levels to create new opportunities and maximize their success. One strategy adopted by ASPO was