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28-10-2016 | Breast cancer | Article

Living well after breast cancer randomized controlled trial protocol: evaluating a telephone-delivered weight loss intervention versus usual care in women following treatment for breast cancer

Journal: BMC Cancer

Authors: Marina M. Reeves, Caroline O. Terranova, Jane M. Erickson, Jennifer R. Job, Denise S. K. Brookes, Nicole McCarthy, Ingrid J. Hickman, Sheleigh P. Lawler, Brianna S. Fjeldsoe, Genevieve N. Healy, Elisabeth A. H. Winkler, Monika Janda, J. Lennert Veerman, Robert S. Ware, Johannes B. Prins, Theo Vos, Wendy Demark-Wahnefried, Elizabeth G. Eakin

Publisher: BioMed Central

Abstract

Background

Obesity, physical inactivity and poor diet quality have been associated with increased risk of breast cancer-specific and all-cause mortality as well as treatment-related side-effects in breast cancer survivors. Weight loss intervention trials in breast cancer survivors have shown that weight loss is safe and achievable; however, few studies have examined the benefits of such interventions on a broad range of outcomes and few have examined factors important to translation (e.g. feasible delivery method for scaling up, assessment of sustained changes, cost-effectiveness). The Living Well after Breast Cancer randomized controlled trial aims to evaluate a 12-month telephone-delivered weight loss intervention (versus usual care) on weight change and a range of secondary outcomes including cost-effectiveness.

Methods/design

Women (18–75 years; body mass index 25–45 kg/m²) diagnosed with stage I-III breast cancer in the previous 2 years are recruited from public and private hospitals and through the state-based cancer registry (target n = 156). Following baseline assessment, participants are randomized 1:1 to either a 12-month telephone-delivered weight loss intervention (targeting diet and physical activity) or usual care. Data are collected at baseline, 6-months (mid-intervention), 12-months (end-of-intervention) and 18-months (maintenance). The primary outcome is change in weight at 12-months. Secondary outcomes are changes in body composition, bone mineral density, cardio-metabolic and cancer-related biomarkers, metabolic health and chronic disease risk, physical function, patient-reported outcomes (quality of life, fatigue, menopausal symptoms, body image, fear of cancer recurrence) and behaviors (dietary intake, physical activity, sitting time). Data collected at 18-months will be used to assess whether outcomes achieved at end-of-intervention are sustained six months after intervention completion. Cost-effectiveness will be assessed, as will mediators and moderators of intervention effects.

Discussion

This trial will provide evidence needed to inform the wide-scale provision of weight loss, physical activity and dietary interventions as part of routine survivorship care for breast cancer survivors.

Trial registration

Australian and New Zealand Clinical Trial Registry (ANZCTR) - ACTRN12612000997853 (Registered 18 September 2012).

Youlden DR, Cramb SM, Dunn NA, Muller JM, Pyke CM, Baade PD. The descriptive epidemiology of female breast cancer: an international comparison of screening, incidence, survival and mortality. Cancer Epidemiol. 2012;36(3):237–48.PubMed

Blanchard CM, Courneya KS, Stein K. Cancer survivors’ adherence to lifestyle behavior recommendations and associations with health-related quality of life: results from the American Cancer Society’s SCS-II. J Clin Oncol. 2008;26(13):2198–204.PubMed

Hair BY, Hayes S, Tse CK, Bell MB, Olshan AF. Racial differences in physical activity among breast cancer survivors: implications for breast cancer care. Cancer. 2014;120(14):2174–82.PubMedPubMedCentral

Jiralerspong S, Kim ES, Dong W, Feng L, Hortobagyi GN, Giordano SH. Obesity, diabetes, and survival outcomes in a large cohort of early-stage breast cancer patients. Ann Oncol. 2013;24(10):2506–14.PubMedPubMedCentral

Mason C, Alfano CM, Smith AW, Wang CY, Neuhouser ML, Duggan C, et al. Long-term physical activity trends in breast cancer survivors. Cancer Epidemiol Biomarkers Prev. 2013;22(6):1153–61.PubMedPubMedCentral

Chan DS, Vieira AR, Aune D, Bandera EV, Greenwood DC, McTiernan A, et al. Body mass index and survival in women with breast cancer-systematic literature review and meta-analysis of 82 follow-up studies. Ann Oncol. 2014;25(10):1901–14.PubMedPubMedCentral

George SM, Ballard-Barbash R, Shikany JM, Caan BJ, Freudenheim JL, Kroenke CH, et al. Better postdiagnosis diet quality is associated with reduced risk of death among postmenopausal women with invasive breast cancer in the women’s health initiative. Cancer Epidemiol Biomarkers Prev. 2014;23(4):575–83.PubMedPubMedCentral

Zhong S, Jiang T, Ma T, Zhang X, Tang J, Chen W, et al. Association between physical activity and mortality in breast cancer: a meta-analysis of cohort studies. Eur J Epidemiol. 2014;29(6):391–404.PubMed

Lahart IM, Metsios GS, Nevill AM, Carmichael AR. Physical activity, risk of death and recurrence in breast cancer survivors: a systematic review and meta-analysis of epidemiological studies. Acta Oncol. 2015;54(5):635–54.PubMed

10.

Demark-Wahnefried W, Campbell KL, Hayes SC. Weight management and its role in breast cancer rehabilitation. Cancer. 2012;118 Suppl 8:S2277–S87.

11.

George SM, Alfano CM, Neuhouser ML, Smith AW, Baumgartner RN, Baumgartner KB, et al. Better postdiagnosis diet quality is associated with less cancer-related fatigue in breast cancer survivors. J Cancer Surviv. 2014;8(4):680–7.PubMed

12.

Imayama I, Alfano CM, Neuhouser ML, George SM, Wilder Smith A, Baumgartner RN, et al. Weight, inflammation, cancer-related symptoms and health related quality of life among breast cancer survivors. Breast Cancer Res Treat. 2013;140(1):159–76.PubMedPubMedCentral

13.

Schmidt ME, Chang-Claude J, Seibold P, Vrieling A, Heinz J, Flesch-Janys D, et al. Determinants of long-term fatigue in breast cancer survivors: results of a prospective patient cohort study. Psychooncology. 2015;24(1):40–6.PubMed

14.

Gho SA, Steele JR, Jones SC, Munro BJ. Self-reported side effects of breast cancer treatment: a cross-sectional study of incidence, associations, and the influence of exercise. Cancer Causes Control. 2013;24(3):517–28.PubMed

15.

Wayne SJ, Baumgartner K, Baumgartner RN, Bernstein L, Bowen DJ, Ballard-Barbash R. Diet quality is directly associated with quality of life in breast cancer survivors. Breast Cancer Res Treat. 2006;96(3):227–32.PubMed

16.

Ligibel JA, Alfano CM, Courneya KS, Demark-Wahnefried W, Burger RA, Chlebowski RT, et al. American society of clinical oncology position statement on obesity and cancer. J Clin Oncol. 2014;32(31):3568–74.PubMedPubMedCentral

17.

Goodwin PJ, Segal RJ, Vallis M, Ligibel JA, Pond GR, Robidoux A, et al. Randomized trial of a telephone-based weight loss intervention in postmenopausal women with breast cancer receiving letrozole: the LISA trial. J Clin Oncol. 2014;32(21):2231–9.PubMed

18.

Harrigan M, Cartmel B, Loftfield E, Sanft T, Chagpar AB, Zhou Y, et al. Randomized trial comparing telephone versus in-person weight loss counseling on body composition and circulating biomarkers in women treated for breast cancer: The Lifestyle, Exercise, and Nutrition (LEAN) study. J Clin Oncol. 2016;34(7):669–76.PubMed

19.

Reeves MM, Terranova CO, Eakin EG, Demark-Wahnefried W. Weight loss intervention trials in women with breast cancer: a systematic review. Obes Rev. 2014;15(9):749–68.PubMed

20.

Rock CL, Flatt SW, Byers TE, Colditz GA, Demark-Wahnefried W, Ganz PA, et al. Results of the Exercise and Nutrition to Enhance Recovery and Good Health for You (ENERGY) Trial: a behavioral weight loss intervention in overweight or obese breast cancer survivors. J Clin Oncol. 2015;33(28):3169–76.PubMedPubMedCentral

21.

Ligibel JA, Alfano CM, Hershman D, Ballard RM, Bruinooge SS, Courneya KS, et al. Recommendations for obesity clinical trials in cancer survivors: American Society of Clinical Oncology statement. J Clin Oncol. 2015;33(33):3961–7.PubMed

22.

Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, et al. 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Obesity Society. Circulation. 2014;129(25 Suppl 2):S102–38.PubMed

23.

National Health and Medical Research Council. Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia. Melbourne: National Health and Medical Research Council; 2013.

24.

Rock CL, Doyle C, Demark-Wahnefried W, Meyerhardt J, Courneya KS, Schwartz AL, et al. Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin. 2012;62(4):243–74.PubMed

25.

World Cancer Research Fund, American Institute for Cancer Research. Food, nutrition, physical activity, and the prevention of cancer: a global perspective. Washington DC: 2007.

26.

Reeves MM, Winkler EAH, McCarthy N, Lawler SP, Terranova CO, Hayes SC, Janda M, Demark-Wahnefried W, Eakin EG. The Living Well after Breast Cancer™ Pilot Trial: A weight loss intervention for women following treatment for breast cancer. Asia Pac J Clin Oncol. 2016; (in press; accepted 11/09/2016).

27.

Spark LC, Fjeldsoe BS, Eakin EG, Reeves MM. Efficacy of a text message-delivered extended contact intervention on maintenance of weight loss, physical activity, and dietary behavior change. JMIR Mhealth Uhealth. 2015;3(3):e88.PubMedPubMedCentral

28.

Donnelly JE, Blair SN, Jakicic JM, Manore MM, Rankin JW, Smith BK. American College of Sports Medicine position stand - appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults. Med Sci Sports Exerc. 2009;41(2):459–71.PubMed

29.

Hayes SC, Spence RR, Galvao DA, Newton RU. Australian Association for Exercise and Sport Science position stand: optimising cancer outcomes through exercise. J Sci Med Sport. 2009;12(4):428–34.PubMed

30.

Biswas A, Oh PI, Faulkner GE, Bajaj RR, Silver MA, Mitchell MS, et al. Sedentary time and its association with risk for disease incidence, mortality, and hospitalization in adults: a systematic review and meta-analysis. Ann Intern Med. 2015;162(2):123–32.PubMed

31.

Wilmot EG, Edwardson CL, Achana FA, Davies MJ, Gorely T, Gray LJ, et al. Sedentary time in adults and the association with diabetes, cardiovascular disease and death: systematic review and meta-analysis. Diabetologia. 2012;55(11):2895–905.PubMed

32.

Aune D, Norat T, Leitzmann M, Tonstad S, Vatten LJ. Physical activity and the risk of type 2 diabetes: a systematic review and dose–response meta-analysis. Eur J Epidemiol. 2015;30(7):529–42.PubMed

33.

Woodcock J, Franco OH, Orsini N, Roberts I. Non-vigorous physical activity and all-cause mortality: systematic review and meta-analysis of cohort studies. Int J Epidemiol. 2011;40(1):121–38.PubMed

34.

Institute of Medicine of the National Academies. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids (macronutrients). 2005. Available from URL: http://www.nap.edu/openbook.php?record_id=10490&page=R1. Accessed 02 Nov 2015.

35.

Bandura A. Social foundations of thought and action: a social cognitive theory. Englewood Cliffs: Prentice Hall; 1986.

36.

Emmons KM, Rollnick S. Motivational interviewing in health care settings. Opportunities and limitations. Am J Prev Med. 2001;20(1):68–74.PubMed

37.

Fjeldsoe B, Phongsavan P, Bauman A, Goode A, Maher G, Eakin E. ‘Get Healthy, Stay Healthy’: protocol for evaluation of a lifestyle intervention delivered by text-message following the Get Healthy Information and Coaching Service(R). BMC Public Health. 2014;14:112.PubMedPubMedCentral

38.

Ross R, Berentzen T, Bradshaw A, Janssen I, Kahn H, Katzmarzyk P, et al. Does the relationship between waist circumference, morbidity and mortality depend on measurement protocol for waist circumference? Obes Rev. 2008;9(4):312–25.PubMed

39.

Villasenor A, Ballard-Barbash R, Baumgartner K, Baumgartner R, Bernstein L, McTiernan A, et al. Prevalence and prognostic effect of sarcopenia in breast cancer survivors: the HEAL Study. J Cancer Surviv. 2012;6(4):398–406.PubMedPubMedCentral

40.

Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis: report of the European working group on sarcopenia in older people. Age Ageing. 2010;39(4):412–23.PubMedPubMedCentral

41.

Henry MJ, Pasco JA, Pocock NA, Nicholson GC, Kotowicz MA. Reference ranges for bone densitometers adopted Australia-wide: Geelong osteoporosis study. Australas Radiol. 2004;48(4):473–5.PubMed

42.

Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972;18(6):499–502.PubMed

43.

Braithwaite D, Moore DH, Satariano WA, Kwan ML, Hiatt RA, Kroenke C, et al. Prognostic impact of comorbidity among long-term breast cancer survivors: results from the LACE study. Cancer Epidemiol Biomarkers Prev. 2012;21(7):1115–25.PubMedPubMedCentral

44.

Patnaik JL, Byers T, Diguiseppi C, Denberg TD, Dabelea D. The influence of comorbidities on overall survival among older women diagnosed with breast cancer. J Natl Cancer Inst. 2011;103(14):1101–11.PubMedPubMedCentral

45.

McCaskill-Stevens W, Abrams JS. Comorbidities in the aging breast cancer population: are current assessments leading to improved outcomes? J Natl Cancer Inst. 2011;103(14):1072–3.PubMedPubMedCentral

46.

Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120(16):1640–5.PubMed

47.

Johnson JL, Slentz CA, Houmard JA, Samsa GP, Duscha BD, Aiken LB, et al. Exercise training amount and intensity effects on metabolic syndrome (from Studies of a Targeted Risk Reduction Intervention through Defined Exercise). Am J Cardiol. 2007;100(12):1759–66.PubMedPubMedCentral

48.

Thomas GA, Alvarez-Reeves M, Lu L, Yu H, Irwin ML. Effect of exercise on metabolic syndrome variables in breast cancer survivors. Int J Endocrinol. 2013;2013:168797.PubMedPubMedCentral

49.

Curb JD, Ceria-Ulep CD, Rodriguez BL, Grove J, Guralnik J, Willcox BJ, et al. Performance-based measures of physical function for high-function populations. J Am Geriatr Soc. 2006;54(5):737–42.PubMed

50.

Hays RD, Bjorner JB, Revicki DA, Spritzer KL, Cella D. Development of physical and mental health summary scores from the patient-reported outcomes measurement information system (PROMIS) global items. Qual Life Res. 2009;18(7):873–80.PubMedPubMedCentral

51.

Yellen SB, Cella DF, Webster K, Blendowski C, Kaplan E. Measuring fatigue and other anemia-related symptoms with the Functional Assessment of Cancer Therapy (FACT) measurement system. J Pain Symptom Manage. 1997;13(2):63–74.PubMed

52.

Van Belle S, Paridaens R, Evers G, Kerger J, Bron D, Foubert J, et al. Comparison of proposed diagnostic criteria with FACT-F and VAS for cancer-related fatigue: proposal for use as a screening tool. Support Care Cancer. 2005;13(4):246–54.PubMed

53.

Greene JG. Constructing a standard climacteric scale. Maturitas. 1998;29(1):25–31.PubMed

54.

Somunkiran A, Erel CT, Demirci F, Senturk ML. The effect of tibolone versus 17beta-estradiol on climacteric symptoms in women with surgical menopause: a randomized, cross-over study. Maturitas. 2007;56(1):61–8.PubMed

55.

Greene JG. Menopause Symptoms: Climacteric Scale. 2015. Available from URL: http://www.menopausematters.co.uk/greenescale.php. Accessed 15 Mar 2016.

56.

Hormes JM, Lytle LA, Gross CR, Ahmed RL, Troxel AB, Schmitz KH. The body image and relationships scale: development and validation of a measure of body image in female breast cancer survivors. J Clin Oncol. 2008;26(8):1269–74.PubMed

57.

Speck RM, Gross CR, Hormes JM, Ahmed RL, Lytle LA, Hwang WT, et al. Changes in the Body Image and Relationship Scale following a one-year strength training trial for breast cancer survivors with or at risk for lymphedema. Breast Cancer Res Treat. 2010;121(2):421–30.PubMed

58.

Thewes B, Zachariae R, Christensen S, Nielsen T, Butow P. The Concerns About Recurrence Questionnaire: validation of a brief measure of fear of cancer recurrence amongst Danish and Australian breast cancer survivors. J Cancer Surviv. 2015;9(1):68–79.PubMed

59.

Stanton AL, Bernaards CA, Ganz PA. The BCPT symptom scales: a measure of physical symptoms for women diagnosed with or at risk for breast cancer. J Natl Cancer Inst. 2005;97(6):448–56.PubMed

60.

Swenson KK, Nissen MJ, Henly SJ, Maybon L, Pupkes J, Zwicky K, et al. Identification of tools to measure changes in musculoskeletal symptoms and physical functioning in women with breast cancer receiving aromatase inhibitors. Oncol Nurs Forum. 2013;40(6):549–57.PubMed

61.

Hausheer FH, Schilsky RL, Bain S, Berghorn EJ, Lieberman F. Diagnosis, management, and evaluation of chemotherapy-induced peripheral neuropathy. Semin Oncol. 2006;33(1):15–49.PubMed

62.

Shimozuma K, Ohashi Y, Takeuchi A, Aranishi T, Morita S, Kuroi K, et al. Feasibility and validity of the Patient Neurotoxicity Questionnaire during taxane chemotherapy in a phase III randomized trial in patients with breast cancer: N-SAS BC 02. Support Care Cancer. 2009;17(12):1483–91.PubMed

63.

Shimozuma K, Ohashi Y, Takeuchi A, Aranishi T, Morita S, Kuroi K, et al. Taxane-induced peripheral neuropathy and health-related quality of life in postoperative breast cancer patients undergoing adjuvant chemotherapy: N-SAS BC 02, a randomized clinical trial. Support Care Cancer. 2012;20(12):3355–64.PubMed

64.

Kozey-Keadle S, Libertine A, Lyden K, Staudenmayer J, Freedson PS. Validation of wearable monitors for assessing sedentary behavior. Med Sci Sports Exerc. 2011;43(8):1561–7.PubMed

65.

Kelly LA, McMillan DG, Anderson A, Fippinger M, Fillerup G, Rider J. Validity of actigraphs uniaxial and triaxial accelerometers for assessment of physical activity in adults in laboratory conditions. BMC Med Phys. 2013;13(1):5.PubMedPubMedCentral

66.

Winkler EA, Gardiner PA, Clark BK, Matthews CE, Owen N, Healy GN. Identifying sedentary time using automated estimates of accelerometer wear time. Br J Sports Med. 2012;46(6):436–42.PubMed

67.

Freedson PS, Melanson E, Sirard J. Calibration of the Computer Science and Applications, Inc. accelerometer. Med Sci Sports Exerc. 1998;30(5):777–81.PubMed

68.

Healy GN, Winkler EA, Owen N, Anuradha S, Dunstan DW. Replacing sitting time with standing or stepping: associations with cardio-metabolic risk biomarkers. Eur Heart J. 2015;36(39):2643–9.PubMed

69.

Australian Institute of Health and Welfare. The Active Australia Survey: A Guide and Manual for Implementation, Analysis and Reporting. Canberra: 2003.

70.

Brown WJ, Burton NW, Marshall AL, Miller YD. Reliability and validity of a modified self-administered version of the Active Australia physical activity survey in a sample of mid-age women. Aust N Z J Public Health. 2008;32(6):535–41.PubMed

71.

Brown WJ, Trost SG, Bauman A, Mummery K, Owen N. Test-retest reliability of four physical activity measures used in population surveys. J Sci Med Sport. 2004;7(2):205–15.PubMed

72.

Lee WY, Clark BK, Winkler E, Eakin EG, Reeves MM. Responsiveness to Change of Self-Report and Device-Based Physical Activity Measures in the Living Well With Diabetes Trial. J Phys Act Health. 2015;12(8):1082–7.PubMed

73.

Reeves MM, Marshall AL, Owen N, Winkler EA, Eakin EG. Measuring physical activity change in broad-reach intervention trials. J Phys Act Health. 2010;7(2):194–202.PubMed

74.

Johnson MF, Sallis JF, Hovell MF. Self-report assessment of walking: effects of aided recall instructions and item order. Meas Phys Educ Exerc Sci. 2000;4(3):141–55.

75.

Conway JM, Ingwersen LA, Vinyard BT, Moshfegh AJ. Effectiveness of the US Department of Agriculture 5-step multiple-pass method in assessing food intake in obese and nonobese women. Am J Clin Nutr. 2003;77(5):1171–8.PubMed

76.

Coyne T, Ibiebele TI, McNaughton S, Rutishauser IHE, O’Dea K, Hodge AM, et al. Evaluation of brief dietary questions to estimate vegetable and fruit consumption using serum carotenoids and red-cell folate. Public Health Nutr. 2005;8(3):298–308.PubMed

77.

Rutishauser IHE, Webb K, Abraham B, Allsopp R. Evaluation of short dietary questions from the 1995 National Nutrition Survey. Canberra: Australian Government Department of Health and Ageing; 2001.

78.

Australian Bureau of Statistics. Australian Standard Geographical Classification (ASGC) Remoteness Area Correspondences, 2006. Canberra: ABS; 2011.

79.

Australian Bureau of Statistics. Census of Population and Housing: Socio-Economic Indexes for Areas (SEIFA), Australia, 2011. Canberra: ABS; 2013.

80.

PROMIS. Depression: A brief guide to the PROMIS depression instruments. Available from URL: http://www.assessmentcenter.net/documents/PROMIS%20Depression%20Scoring%20Manual.pdf. Accessed 30 Aug 2015.

81.

Amtmann D, Kim J, Chung H, Bamer AM, Askew RL, Wu S, et al. Comparing CESD-10, PHQ-9, and PROMIS depression instruments in individuals with multiple sclerosis. Rehabil Psychol. 2014;59(2):220–9.PubMedPubMedCentral

82.

Rodgers WM, Brawley LR. The role of outcome expectancies in participation motivation. J Sport Exerc Psychol. 1991;13:411–27.

83.

Zunft HJ, Friebe D, Seppelt B, de Graaf C, Margetts B, Schmitt A, et al. Perceived benefits of healthy eating among a nationally-representative sample of adults in the European Union. Eur J Clin Nutr. 1997;51 Suppl 2:S41–6.PubMed

84.

Courneya KS, Jones LW, Mackey JR, Fairey AS. Exercise beliefs of breast cancer survivors before and after participation in a randomized controlled trial. Int J Behav Med. 2006;13(3):259–64.PubMed

85.

Petosa SP. Use of social cognitive theory to explain exercise behavior among adults. Ohio: The Ohio State University; 1993.

86.

Linde JA, Rothman AJ, Baldwin AS, Jeffery RW. The impact of self-efficacy on behavior change and weight change among overweight participants in a weight loss trial. Health Psychol. 2006;25(3):282–91.PubMed

87.

Marcus BH, Selby VC, Niaura RS, Rossi JS. Self-efficacy and the stages of exercise behavior change. Res Q Exerc Sport. 1992;63(1):60–6.PubMed

88.

Sallis JF, Grossman RM, Pinski RB, Patterson TL, Nader PR. The development of scales to measure social support for diet and exercise behaviors. Prev Med. 1987;16(6):825–36.PubMed

89.

Alexander A, Bergman P, Hagströmer M, Sjöström M. IPAQ environmental module; reliability testing. J Public Health. 2006;14(2):76–80.

90.

Dibsdall LA, Lambert N, Bobbin RF, Frewer LJ. Low-income consumers’ attitudes and behaviour towards access, availability and motivation to eat fruit and vegetables. Public Health Nutr. 2003;6(2):159–68.PubMed

91.

Moore LV, Diez Roux AV, Nettleton JA, Jacobs Jr DR. Associations of the local food environment with diet quality--a comparison of assessments based on surveys and geographic information systems: the multi-ethnic study of atherosclerosis. Am J Epidemiol. 2008;167(8):917–24.PubMedPubMedCentral

92.

Jen KL, Djuric Z, DiLaura NM, Buison A, Redd JN, Maranci V, et al. Improvement of metabolism among obese breast cancer survivors in differing weight loss regimens. Obes Res. 2004;12(2):306–12.PubMed

93.

Cella D, Yount S, Sorensen M, Chartash E, Sengupta N, Grober J. Validation of the Functional Assessment of Chronic Illness Therapy Fatigue Scale relative to other instrumentation in patients with rheumatoid arthritis. J Rheumatol. 2005;32(5):811–9.PubMed

94.

Fisher MI, Davies C, Beuthin C, Colon G, Zoll B, Pfalzer L. Breast Cancer EDGE Task Force outcomes - clinical measures of strength and muscular endurance: a systematic review. Rehabil Oncol. 2014;32(4):6–15.

95.

Hayes SC, Rye S, Disipio T, Yates P, Bashford J, Pyke C, et al. Exercise for health: a randomized, controlled trial evaluating the impact of a pragmatic, translational exercise intervention on the quality of life, function and treatment-related side effects following breast cancer. Breast Cancer Res Treat. 2013;137(1):175–86.PubMed

96.

Vardar Yagli N, Sener G, Arikan H, Saglam M, Inal Ince D, Savci S, et al. Do yoga and aerobic exercise training have impact on functional capacity, fatigue, peripheral muscle strength, and quality of life in breast cancer survivors? Integr Cancer Ther. 2015;14(2):125–32.PubMed

97.

Forster M, Veerman JL, Barendregt JJ, Vos T. Cost-effectiveness of diet and exercise interventions to reduce overweight and obesity. Int J Obes. 2011;35(8):1071–8.

98.

Vos T, Carter R, Barendregt J, Mihalopoulos C, Veerman JL, Magnus A, et al. Assessing Cost-Effectiveness in Prevention (ACE-Prevention): final report. Melbourne: The University of Queensland, Brisbane and Deakin University; 2010.

99.

Murray CJ, Barber RM, Foreman KJ, Abbasoglu Ozgoren A, Abd-Allah F, Abera SF, et al. Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990–2013: quantifying the epidemiological transition. Lancet. 2015;386(10009):2145–91.PubMed

100.

D’Agostino RB, Russell MW, Huse DM, Ellison RC, Silbershatz H, Wilson PW, et al. Primary and subsequent coronary risk appraisal: new results from the Framingham study. Am Heart J. 2000;139(2 Pt 1):272–81.PubMed

101.

Dansinger ML, Tatsioni A, Wong JB, Chung M, Balk EM. Meta-analysis: the effect of dietary counseling for weight loss. Ann Intern Med. 2007;147(1):41–50.PubMed

102.

Salomon JA, Haagsma JA, Davis A, de Noordhout CM, Polinder S, Havelaar AH, et al. Disability weights for the Global Burden of Disease 2013 study. Lancet Glob Health. 2015;3(11):e712–23.PubMed

103.

Jacobs P, Fassbender K. The measurement of indirect costs in the health economics evaluation literature. A review. Int J Technol Assess Health Care. 1998;14(4):799–808.PubMed

104.

Vos T, Carter R, Doran C, Anderson I, Lopez AD, Wilson A. Assessing Cost-Effectiveness in the Prevention of Non-Communicable Disease (ACE–Prevention) Economic Evaluation Protocol. Brisbane: The University of Queensland; 2007.

105.

Befort CA, Klemp JR, Austin HL, Perri MG, Schmitz KH, Sullivan DK, et al. Outcomes of a weight loss intervention among rural breast cancer survivors. Breast Cancer Res Treat. 2012;132(2):631–9.PubMed

106.

Djuric Z, DiLaura NM, Jenkins I, Darga L, Jen CK, Mood D, et al. Combining weight-loss counseling with the weight watchers plan for obese breast cancer survivors. Obes Res. 2002;10(7):657–65.PubMed

107.

Harris MN, Swift DL, Myers VH, Earnest CP, Johannsen NM, Champagne CM, et al. Cancer survival through lifestyle change (CASTLE): a pilot study of weight loss. Int J Behav Med. 2013;20(3):403–12.PubMed

108.

Eakin EG, Hayes SC, Haas MR, Reeves MM, Vardy JL, Boyle F, et al. Healthy Living after Cancer: a dissemination and implementation study evaluating a telephone-delivered healthy lifestyle program for cancer survivors. BMC Cancer. 2015;15(1):992.PubMedPubMedCentral