title: Physical activity, additional breast cancer events, and mortality among early-stage breast cancer survivors: findings from the WHEL Study Safety and Efficacy of Weight Training in Recent Breast Cancer Survivors to Alter Body Composition, Insulin, and Insulin-Like Growth Factor Axis Proteins A pilot trial of spirituality counseling for weight loss maintenance in African American breast cancer survivors. 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. Objective Assessment of Physical Activity: Classifiers for Public Health. A Lifestyle Intervention via Email in Minority Breast Cancer Survivors: Randomized Parallel-Group Feasibility Study Differential Patterns of Risk Factors for Early-Onset Breast Cancer by ER Status in African American Women A pilot randomized controlled trial of a commercial diet and exercise weight loss program in minority breast cancer survivors. Greater survival after breast cancer in physically active women with high vegetable-fruit intake regardless of obesity. Body and soul. A dietary intervention conducted through African-American churches. Epidemiology of breast cancer subtypes in two prospective cohort studies of breast cancer survivors Too much sitting: the population health science of sedentary behavior. Physical activity and survival after breast cancer diagnosis. A Weight Loss Intervention for African American Breast Cancer Survivors, 2006 Dietary patterns and survival in German postmenopausal breast cancer survivors Physical Activity and Survival after Diagnosis of Invasive Breast Cancer The German SUCCESS C Study – The First European Lifestyle Study on Breast Cancer Exercise and dietary advice intervention for survivors of triple-negative breast cancer: effects on body fat, physical function, quality of life, and adipokine profile Efficacy of a Weight Loss Intervention for African American Breast Cancer Survivors. A Community-Based Exercise and Support Group Program in African-American Breast Cancer Survivors (ABCs). Evaluating the dissemination of Body & Soul, an evidence-based fruit and vegetable intake intervention: challenges for dissemination and implementation research. 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. Dietary patterns and survival after breast cancer diagnosis. Dietary fat reduction and breast cancer outcome: interim efficacy results from the Women's Intervention Nutrition Study. Preventing weight gain in African American breast cancer survivors using smart scales and activity trackers: a randomized controlled pilot study Effects of exercise interventions during different treatments in breast cancer. A dance intervention for cancer survivors and their partners (RHYTHM) Influence of pre- and postdiagnosis physical activity on mortality in breast cancer survivors: the health, eating, activity, and lifestyle study. Detailed methods of two home-based vegetable gardening intervention trials to improve diet, physical activity, and quality of life in two different populations of cancer survivors. Randomized controlled trial of yoga among a multiethnic sample of breast cancer patients: effects on quality of life. Lifestyle and breast cancer recurrences: the DIANA-5 trial. Study design and methods for the ACTIVity And TEchnology (ACTIVATE) trial. Objectively measured physical activity and sedentary behavior and quality of life indicators in survivors of breast cancer Randomized trial of a telephone-based weight loss intervention in postmenopausal women with breast cancer receiving letrozole: the LISA trial.
abstract: Objective Research suggests that physical activity is associated with improved breast cancer survival , yet no studies have examined the association between post-diagnosis changes in physical activity and breast cancer outcomes . The aim of this study was to determine whether baseline activity and 1-year change in activity are associated with breast cancer events or mortality . Methods A total of 2,361 post-treatment breast cancer survivors ( Stage I – III ) enrolled in a r and omized controlled trial of dietary change completed physical activity measures  at baseline and one year .  Physical activity variables ( total , moderate – vigorous , and adherence to guidelines )  were calculated for each time point . Median follow-up was 7.1 years . Outcomes were invasive breast cancer events and all-cause mortality . Results Those who were most active at baseline had a 53 % lower mortality risk compared to the least active women ( HR = 0.47 ; 95 % CI : 0.26 , 0.84 ; p = .01 ) . Adherence to activity guidelines was associated with a 35 % lower mortality risk ( HR = 0.65 , 95 % CI : 0.47 , 0.91 ; p < .01 ) . Neither baseline nor 1-year change in activity was associated with additional breast cancer events . Conclusions Higher baseline ( post-treatment ) physical activity was associated with improved survival . However , change in activity over the following year was not associated with outcomes . These data suggest that long-term physical activity levels are important for breast cancer prognosis Background : This r and omized controlled trial assessed the safety and effects of twice-weekly weight training among recent breast cancer survivors . Outcomes included body size and biomarkers hypothesized to link exercise and breast cancer risk . Methods : A convenience sample of 85 recent survivors was r and omized into immediate and delayed treatment groups . The immediate group trained from months 0 to 12 ; the delayed treatment group served as a no exercise parallel comparison group from months 0 to 6 and trained from months 7 to 12 . Measures at baseline , 6 and 12 months included body weight , height , body fat , lean mass , body fat % , and waist circumference , as well as fasting glucose , insulin , insulin resistance , insulin-like growth factor-I ( IGF-I ) , IGF-II , and IGF-binding protein-1 , IGFBP-2 , and IGFBP-3 . Injury reporting was st and ardized . Results : The intervention result ed in significant increases in lean mass ( 0.88 versus 0.02 kg , P < 0.01 ) , as well as significant decreases in body fat % ( −1.15 % versus 0.23 % , P = 0.03 ) and IGF-II ( −6.23 versus 28.28 ng/mL , P = 0.02 ) comparing immediate with delayed treatment from baseline to 6 months . Within-person changes experienced by delayed treatment group participants during training versus no training were similar . Only one participant experienced a study related injury that prevented continued participation . Conclusion : Twice-weekly weight training is a safe exercise program for recent breast cancer survivors that may result in increased muscle mass , as well as decreased body fat % and IGF-II . The implication s of these results on cancer recurrence or survival may become more evident with longer exercise intervention trials among breast cancer survivors A continuing challenge in weight loss treatment is attaining maintenance of weight loss . The goal of this study was to develop a counseling method that would assist African American breast cancer survivors with weight loss maintenance . In this pilot study , 31 obese breast cancer survivors were recruited .  Individualized , dietitian-led counseling by telephone and free Weight Watchers coupons were provided to all participants for 18 months . At the 6-month time point , women were r and omized to receive spirituality counseling or not in addition to the st and ard program . The spirituality counseling was delivered via telephone using an 8-step framework . Subjects were asked to utilize  daily meditation or prayer , daily readings  , and the recording of thoughts in a journal . Mean weight loss from baseline to 6 months was a modest 2.0 % of baseline weight . From 6 to 18 months , there was no further weight change in the spirituality arm and a gain of 0.7 % in the dietitian-only arm . Despite little effect on weight loss , it did appear that spirituality counseling positively affected spiritual well-being ( FACIT-Sp ) scores and dietary quality . The spirituality counseling framework therefore may be further refined and useful for other health promotion studies with African American population PURPOSE Obesity increases risk for all-cause and breast cancer mortality and comorbidities in women who have been diagnosed and treated for breast cancer . The Exercise and Nutrition to Enhance Recovery and Good Health for You ( ENERGY ) study is the largest weight loss intervention trial among survivors of breast cancer to date . METHODS In this multicenter trial , 692 overweight/obese women who were , on average , 2 years since primary treatment for early-stage breast cancer were r and omly assigned to either a group-based behavioral intervention , supplemented with telephone counseling and tailored newsletters , to support weight loss or a less intensive control intervention and observed for 2 years . Weight and blood pressure were measured at 6 , 12 , 18 , and 24 months . Longitudinal mixed models were used to analyze change over time . RESULTS At 12 months , mean weight loss was 6.0 % of initial weight in the intervention group and 1.5 % in the control group ( P<.001 ) . At 24 months , mean weight loss in the intervention and control groups was 3.7 % and 1.3 % , respectively ( P<.001 ) . Favorable effects of the intervention on physical activity and blood pressure were observed . The weight loss intervention was more effective among women older than 55 years than among younger women . CONCLUSION A behavioral weight loss intervention can lead to clinical ly meaningful weight loss in overweight/obese survivors of breast cancer . These findings support the need to conduct additional studies to test methods that support sustained weight loss and to examine the potential benefit of intentional weight loss on breast cancer recurrence and survival PURPOSE Walking for health is recommended by health agencies , partly based on epidemiological studies of self-reported behaviors . Accelerometers are now replacing survey data , but it is not clear that intensity-based cut points reflect the behaviors previously reported . New computational techniques can help classify raw accelerometer data into behaviors meaningful for public health . METHODS Five hundred twenty days of triaxial 30-Hz accelerometer data from three studies ( n = 78 ) were employed as training data . Study 1 included prescribed activities completed in natural setting s. The other two studies included multiple days of free-living data  with SenseCam-annotated ground truth . The two population s in the free-living data sets were demographically and physical different . R and om forest classifiers were trained on each data set , and the classification accuracy on the training data set and that applied to the other available data sets were assessed . Accelerometer cut points were also compared with the ground truth from the three data sets . RESULTS The r and om forest classified all behaviors with over 80 % accuracy . Classifiers developed on the prescribed data performed with higher accuracy than the free-living data classifier , but these did not perform as well on the free-living data sets . Many of the observed behaviors occurred at different intensities compared with those identified by existing cut points . CONCLUSIONS New machine learning classifiers developed from prescribed activities ( study 1 ) were considerably less accurate when applied to free-living population s or to a functionally different population ( studies 2 and 3 ) . These classifiers , developed on free-living data , may have value when applied to large cohort studies with existing hip accelerometer data Background Our data have indicated that minority breast cancer survivors are receptive to participating in lifestyle interventions delivered via email or the Web , yet few Web-based studies exist in this population . Objective The aim of this study was to examine the feasibility and preliminary results of an email-delivered diet and activity intervention program , “ A Lifestyle Intervention Via Email ( ALIVE ) , ” delivered to a sample of racial and ethnic minority breast cancer survivors . Methods Survivors ( mean age : 52 years , 83 % [ 59/71 ] African American ) were recruited and r and omized to receive either the ALIVE program ’s 3-month physical activity track or its 3-month dietary track . The fully automated system provided tools for self-monitoring and goal setting , tailored content , and automated phone calls . Descriptive statistics and mixed-effects models were computed to examine the outcomes of the study . Results Upon completion , 44 of 71 survivors completed the study . Our “ intention-to-treat ” analysis revealed that participants in the physical activity track made greater improvements in moderate to vigorous activity than those in the dietary track ( + 97 vs. + 49 min/week , P<.001 ) . Similarly , reductions in total sedentary time among those in the physical activity track ( −304 vs. −59 min/week , P<.001 ) was nearly 5 times greater than that for participants in the dietary track . Our completers case analysis indicated that participants in the dietary track made improvements in the intake of fiber ( + 4.4 g/day ) , fruits and vegetables ( + 1.0 cup equivalents/day ) , and reductions in saturated fat ( −2.3 g/day ) and trans fat ( −0.3 g/day ) ( all P<.05 ) . However , these improvements in dietary intake were not significantly different from the changes observed by participants in the physical activity track ( all P>.05 ) . Process evaluation data indicated that most survivors would recommend ALIVE to other cancer survivors ( 97 % ) , were satisfied with ALIVE ( 82 % ) , and felt that ALIVE was effective ( 73 % ) . However , survivors expressed concerns about the functionality of the interactive emails . Conclusions ALIVE appears to be feasible for racial and ethnic minority cancer survivors and showed promising results for larger implementation . Although survivors favored the educational content , a mobile phone app and interactive emails that work on multiple email domains may help to boost adherence rates and to improve satisfaction with the Web-based platform . Trial Registration Clinical Trials.gov NCT02722850 ; https:// clinical trials.gov/ct2/show/NCT02722850 ( Archived by WebCite at http://www.webcitation.org/6tHN9VsPh Background : Given the disproportionately high incidence of early-onset breast cancer and aggressive subtypes , such as estrogen receptor (ER)-negative tumors , in African American ( AA ) women , elucidation of risk factors for early onset of specific subtypes of breast cancer is needed . Methods : We evaluated associations of reproductive , anthropometric , and other factors with incidence of invasive breast cancer  by age at onset ( < 45 , ≥45 ) in 57,708 AA women in the prospect i ve Black Women 's Health Study . From 1995 to 2013 , we identified 529 invasive breast cancers among women < 45 years of age ( 151 ER− , 219 ER+ ) and 1,534 among women ≥45 years ( 385 ER− , 804 ER+ ) . We used multivariable Cox proportional hazards regression to estimate hazard ratios ( HRs ) for associations by age and ER status . Results : Higher parity , older age at first birth , never having breastfed , and abdominal adiposity were associated with increased risk of early-onset ER− breast cancer : HRs were 1.71 for ≥3 births versus one birth ; 2.29 for first birth after age 25 versus < 20 years ; 0.61 for ever having breastfed versus never ; and 1.64 for highest versus lowest tertile of waist-to-hip ratio . These factors were not associated with ER− cancer in older women or with ER+ cancer regardless of age . Conclusions : Differences in risk factors by ER subtype were observed for breast cancer diagnosed before the age of 45 years . Impact : Etiological heterogeneity by tumor subtype in early-onset breast cancer , in combination with a higher prevalence of the risk factors in AA women , may explain , in part , racial disparities in breast cancer incidence . Cancer Epidemiol Biomarkers Prev ; 26(2 ) ; 270–7 . © 2016 AACR OBJECTIVE Obesity is associated with poorer breast cancer outcomes and losing weight postdiagnosis may improve survival . As Hispanic and black women have poorer breast cancer prognosis than non-Hispanic whites diagnosed at similar age and stage , and have higher rates of obesity , effective weight loss strategies are needed . We piloted a r and omized , waitlist-controlled , crossover study to examine the effects and feasibility of the commercial Curves weight loss program among Hispanic , African American and Afro-Caribbean breast cancer survivors . DESIGN AND METHODS Women with stage 0-IIIa breast cancer ≥ 6 months posttreatment , sedentary , and BMI ≥ 25 kg/m(2 ) were r and omized to the immediate arm ( IA ) : 6 months of the Curves program followed by 6 months of observation ; or the waitlist control arm ( WCA ) : 6 months of observation followed by 6 months of the Curves program . The Curves program uses a 30-min exercise circuit and a high-vegetable/low-fat/calorie-restricted diet . RESULTS A total of 42 women enrolled ( 79 % Hispanic , 21 % black ) , mean age 51 ( range 32 - 69 ) and mean BMI 33.2(± 5.9 ) kg/m(2 ) ; 91 % were retained at month 12 . At month 6 , women in the IA lost an average 3.3 % ( ± 3.5 % ) of body weight ( range : 1.7 % gain to 10.6 % loss ) , as compared with 1.8 % ( ± 2.9 % ) weight loss in the WCA ( P = 0.04 ) . At month 12 , on average women in the IA regained some but not all of the weight lost during the first 6 months ( P = 0.02 ) . CONCLUSIONS Minority breast cancer survivors were recruited and retained in a weight loss study . Six months of the Curves program result ed in moderate weight loss , but weight loss was not maintained postintervention . Future interventions should identify methods to increase uptake and maintenance of weight loss behaviors PURPOSE Single-variable analyses have associated physical activity , diet , and obesity with survival  after breast cancer . This report investigates interactions among these variables . PATIENTS AND METHODS A prospect i ve study was performed of 1,490 women diagnosed and treated for early-stage breast cancer between 1991 and 2000 . Enrollment was an average of 2 years postdiagnosis . Only seven women were lost to follow-up through December 2005 . RESULTS In univariate analysis , reduced mortality was weakly associated with higher vegetable-fruit consumption , increased physical activity , and a body mass index that was neither low weight nor obese . In a multivariate Cox model , only the combination of consuming five or more daily servings of vegetables-fruits , and accumulating 540 + metabolic equivalent tasks-min/wk ( equivalent to walking 30 minutes 6 d/wk ) , was associated with a significant survival advantage ( hazard ratio , 0.56 ; 95 % CI , 0.31 to 0.98 ) . The approximate 50 % reduction in risk associated with these healthy lifestyle behaviors was observed in both obese and nonobese women , although fewer obese women were physically active with a healthy dietary pattern ( 16 % v 30 % ) . Among those who adhered to this healthy lifestyle , there was no apparent effect of obesity on survival . The effect was stronger in women who had hormone receptor-positive cancers . CONCLUSION A minority of breast cancer survivors follow a healthy lifestyle that includes both recommended intakes of vegetables-fruits and moderate levels of physical activity . The strong protective effect observed suggests a need for additional investigation of the effect of the combined influence of diet and physical activity on breast cancer survival OBJECTIVES Body and Soul was a collaborative effort among two research universities , a national voluntary agency ( American Cancer Society ) , and the National Institutes of Health to disseminate and evaluate under real-world conditions the impact of previously developed dietary interventions for African Americans . METHODS Body and Soul was constructed from two successful research -based interventions conducted in African-American churches . Components deemed essential from the prior interventions were combined , and then tested in a cluster r and omized-effectiveness trial . The primary outcome was fruit and vegetable intake measured with two types of food frequency question naires  at baseline and 6-month follow-up . RESULTS At the 6-month follow-up , intervention participants showed significantly greater fruit and vegetable ( F&V ) intake relative to controls . Post-test differences were 0.7 and 1.4 servings for the 2-item and 17-item F&V frequency measures , respectively . Statistically significant positive changes in fat intake , motivation to eat F&V , social support , and efficacy to eat F&V were also observed . CONCLUSIONS The results suggest that research -based interventions , delivered collaboratively by community volunteers and a health-related voluntary agency , can be effectively implemented under real-world conditions Introduction The aim of this study was to describe breast tumor subtypes by common breast cancer risk factors and to determine correlates of subtypes using baseline data from two pooled prospect i ve breast cancer studies within a large health maintenance organization . Methods Tumor data on 2544 invasive breast cancer cases subtyped by estrogen receptor , progesterone receptor , and human epidermal growth factor receptor 2 ( Her2 ) status were obtained ( 1868 luminal A tumors , 294 luminal B tumors , 288 triple-negative tumors and 94 Her2-overexpressing tumors ) . Demographic , reproductive and lifestyle information was collected either in person or by mailed question naires .  Case-only odds ratios ( ORs ) and 95 % confidence intervals ( CIs ) were estimated using logistic regression , adjusting for age at diagnosis , race/ethnicity , and study origin . Results Compared with luminal A cases , luminal B cases were more likely to be younger at diagnosis ( P = 0.0001 ) and were less likely to consume alcohol ( OR = 0.74 , 95 % CI = 0.56 to 0.98 ) , use hormone replacement therapy ( HRT ) ( OR = 0.66 , 95 % CI = 0.46 to 0.94 ) , and oral contraceptives ( OR = 0.73 , 95 % CI = 0.55 to 0.96 ) . Compared with luminal A cases , triple-negative cases tended to be younger at diagnosis ( P ≤ 0.0001 ) and African American ( OR = 3.14 , 95 % CI = 2.12 to 4.16 ) , were more likely to have not breastfed if they had parity greater than or equal to three ( OR = 1.68 , 95 % CI = 1.00 to 2.81 ) , and were more likely to be overweight ( OR = 1.82 , 95 % CI = 1.03 to 3.24 ) or obese ( OR = 1.97 , 95 % CI = 1.03 to 3.77 ) if premenopausal . Her2-overexpressing cases were more likely to be younger at diagnosis ( P = 0.03 ) and Hispanic ( OR = 2.19 , 95 % CI = 1.16 to 4.13 ) or Asian ( OR = 2.02 , 95 % CI = 1.05 to 3.88 ) , and less likely to use HRT ( OR = 0.45 , 95 % CI = 0.26 to 0.79 ) . Conclusions These observations suggest that investigators should consider tumor heterogeneity in associations with traditional breast cancer risk factors . Important modifiable lifestyle factors that may be related to the development of a specific tumor subtype , but not all subtypes , include obesity , breastfeeding , and alcohol consumption . Future work that will further categorize triple-negative cases into basal and non-basal tumors may help to eluci date these associations further Even when adults meet physical activity guidelines , sitting for prolonged periods can compromise metabolic health .  Television ( TV ) time and objective measurement studies show deleterious associations , and breaking up sedentary time is beneficial .  Sitting time , TV time , and time sitting in automobiles increase premature mortality risk . Further evidence from prospect i ve studies , intervention trials , and population -based behavioral studies is required CONTEXT Physical activity has been shown to decrease the incidence of breast cancer , but the effect on recurrence or survival after a breast cancer diagnosis is not known . OBJECTIVE To determine whether physical activity among women with breast cancer decreases their risk of death from  breast cancer  compared with more sedentary women . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve observational study based on responses from 2987 female registered nurses in the Nurses ' Health Study who were diagnosed with stage I , II , or III breast cancer between 1984 and 1998 and who were followed up until death or June 2002 , whichever came first . MAIN OUTCOME MEASURE Breast cancer mortality risk according to  physical activity  category ( <3 , 3 - 8.9 , 9 - 14.9 , 15 - 23.9 , or > or = 24 metabolic equivalent task [ MET ] hours per week ) . RESULTS Compared with women who engaged in less than 3 MET-hours per week of physical activity , the adjusted relative risk ( RR ) of death from breast cancer was 0.80 ( 95 % confidence interval [ CI ] , 0.60 - 1.06 ) for 3 to 8.9 MET-hours per week ; 0.50 ( 95 % CI , 0.31 - 0.82 ) for 9 to 14.9 MET-hours per week ; 0.56 ( 95 % CI , 0.38 - 0.84 ) for 15 to 23.9 MET-hours per week ; and 0.60 ( 95 % CI , 0.40 - 0.89 ) for 24 or more MET-hours per week ( P for trend = .004 ) . Three MET-hours is equivalent to walking at average pace of 2 to 2.9 mph for 1 hour . The benefit of physical activity was particularly apparent among women with hormone-responsive tumors . The RR of breast cancer death for women with hormone-responsive tumors who engaged in 9 or more MET-hours per week of activity compared with women with hormone-responsive tumors who engaged in less than 9 MET-hours per week was 0.50 ( 95 % CI , 0.34 - 0.74 ) . Compared with women who engaged in less than 3 MET-hours per week of activity , the absolute unadjusted mortality risk reduction was 6 % at 10 years for women who engaged in 9 or more MET-hours per week . CONCLUSIONS Physical activity after a breast cancer diagnosis may reduce the risk of death from this disease . The greatest benefit occurred in women who performed the equivalent of walking 3 to 5 hours per week at an average pace , with little evidence of a correlation between increased benefit and greater energy expenditure . Women with breast cancer who follow US physical activity recommendations may improve their survival Introduction Breast cancer survival rates are lower for African American women than for white women . Obesity , high-fat diets , and lack of regular physical activity increase risk for breast cancer recurrence , comorbid conditions , and premature death . Eighty-two percent of African American women are overweight or obese , partly because of unhealthy eating and exercise patterns . Although successful weight loss and lifestyle interventions for breast cancer survivors are documented , none has considered the needs of African American breast cancer survivors . This study assessed the feasibility and impact of Moving Forward , a culturally tailored weight loss program for African American breast cancer survivors . Methods The study used a pre-post design with a convenience sample of 23 African American breast cancer survivors . The 6-month intervention was theory-based and incorporated qualitative data from focus groups with the targeted community , urban African American breast cancer survivors .  Data on weight , body mass index ( BMI ) , diet , physical activity , social support , and quality of life were collected at baseline and at 6 months . Results After the intervention , we noted significant differences in weight , BMI , dietary fat intake , vegetable consumption , vigorous physical activity , and social support . Conclusion This is the first published report of Moving Forward , a weight loss intervention design ed for African American breast cancer survivors . Although a r and omized trial is needed to establish efficacy , the positive results of this intervention suggest that this weight loss intervention may be feasible for African American breast cancer survivors . Lifestyle interventions may reduce the disparities in breast cancer mortality rates Background : Research on the association between dietary patterns and breast cancer survival is very limited . Methods : A prospect i ve follow-up study was conducted in Germany , including 2522 postmenopausal breast cancer patients diagnosed in 2001–2005 with available food frequency question naire data .  Vital status , causes of death , and recurrences were verified through the end of 2009 . Principle component factor analysis was used to identify pre-diagnostic dietary patterns .  Hazard ratios ( HRs ) and 95 % confidence intervals ( CIs ) were calculated with Cox proportional hazards models . Results : Two major dietary patterns were identified : ‘ healthy ’ ( high intakes of vegetables , fruits , vegetable oil , sauces/condiments , and soups/bouillons ) and ‘ unhealthy ’ ( high intakes of red meat , processed meat , and deep-frying fat ) . Increasing consumption of an ‘ unhealthy ’ dietary pattern was associated with an increased risk of non-breast cancer mortality ( highest vs lowest quartile : HR , 3.69 ; 95 % CI , 1.66–8.17 ; P-trend < 0.001 ) . No associations with breast cancer-specific mortality and breast cancer recurrence were found . The ‘ healthy ’ dietary pattern was inversely associated with overall mortality ( HR , 0.74 ; 95 % CI , 0.47–1.15 ; P-trend=0.02 ) and breast cancer recurrence ( HR , 0.71 ; 95 % CI , 0.48–1.06 ; P-trend=0.02 ) in stage I – IIIa patients only . Conclusion : Increasing intake of an ‘ unhealthy ’ pre-diagnostic dietary pattern may increase the risk of non-breast cancer mortality , whereas increasing intake of a ‘ healthy ’ pattern may reduce the risk of overall mortality and breast cancer recurrence Previous studies suggest that increased physical activity may lower the risk of breast cancer incidence , but less is known about whether levels of physical activity after breast cancer diagnosis can influence survival . We prospect ively examined the relation between postdiagnosis recreational physical activity and risk of breast cancer death  in women who had a previous invasive breast cancer diagnosed between 1988 and 2001 ( at ages 20 - 79 years ) . All women completed a question naire on recent  postdiagnosis physical activity and other lifestyle factors . Among 4,482 women without history of recurrence at the time of completing the question naire , 109 died from breast cancer within 6 years of enrollment .  Physical activity was expressed as metabolic equivalent task-hours per week ( MET-h/wk ) ; hazard ratios ( HR ) and 95 % confidence intervals ( 95 % CI ) were estimated using Cox proportional hazards regression . After adjusting for age at diagnosis , stage of disease , state of residence , interval between diagnosis and physical activity assessment , body mass index , menopausal status , hormone therapy use , energy intake , education , family history of breast cancer , and treatment modality compared with women expending < 2.8 MET-h/wk in physical activity , women who engaged in greater levels of activity had a significantly lower risk of dying from breast cancer ( HR , 0.65 ; 95 % CI , 0.39 - 1.08 for 2.8 - 7.9 MET-h/wk ; HR , 0.59 ; 95 % CI , 0.35 - 1.01 for 8.0 - 20.9 MET-h/wk ; and HR , 0.51 ; 95 % CI , 0.29 - 0.89 for ≥21.0 MET-h/wk ; P for trend = 0.05 ) . Results were similar for overall survival ( HR , 0.44 ; 95 % CI , 0.32 - 0.60 for ≥21.0 versus < 2.8 MET-h/wk ; P for trend < 0.001 ) and were similar regardless of a woman ’s age , stage of disease , and body mass index . This study provides support for reduced overall mortality and mortality from breast cancer among women who engage in physical activity  after breast cancer diagnosis . ( Cancer Epidemiol Biomarkers Prev 2008;17(2):379–86 Cohort trials have shown evidence that obesity and a low level of physical activity are not only associated with a higher risk of developing breast cancer , but also with an increased risk for recurrence and reduced survival in breast cancer patients . The SUCCESS C study is the first European trial to evaluate the effect of an intensive lifestyle intervention program on disease-free survival in women with early breast cancer and to examine the predictive value of selected biomarker c and i date s. A total of 3,547 women with early-stage , Her2/neu-negative breast cancer will be included . The first r and omization will compare disease-free survival in patients treated with either 3 cycles of FEC ( epirubicine , fluorouracil , cyclophosphamide ) , followed by 3 cycles of docetaxel or 6 cycles of docetaxel-cyclophosphamide , and thus assess the role of anthracycline-free chemotherapy . The second r and omization compares disease-free survival in patients with a body mass index of 24–40 kg/m2 receiving either a telephone-based individualized lifestyle intervention program aim ing at moderate weight loss or general recommendations for a healthy lifestyle alone . In addition , the study will evaluate the predictive role of cancer-associated and obesity-related biomarkers for the prediction of disease recurrence and survival . This SUCCESS C trial will provide valuable information on the effects of a lifestyle intervention program on the prognosis of early breast cancer patients Purpose Regular exercise and healthy eating are routinely recommended for breast cancer survivors , and past studies show benefits in quality of life and decreased inflammation . However , this has not been tested specifically in triple-negative breast cancer survivors . Increasing physical activity and losing body fat are thought to positively affect inflammatory biomarkers that have been associated with breast cancer . Therefore , the primary purpose of this study was to determine if participation in an exercise and dietary counseling program can improve body fat , physical function , and quality of life in survivors of this aggressive breast cancer . Secondarily , we sought to determine if participation in the program had beneficial effects on obesity-related markers of the adipokine profile . Methods Sixty-six survivors of triple-negative breast cancer with BMI > 25 were invited to participate . Twenty-eight enrolled and 23 completed the r and omized , controlled trial ( 13 intervention , 10 control ) . Moderate-intensity aerobic exercise ( 150 min per week , for 12 weeks ) and diet counseling were compared to usual care , education only . The primary outcome of interest was weight loss ( body mass , BMI , % fat ) , and secondary outcomes included physical function ( exercise capacity ) , quality of life ( Function After Cancer Therapy — Breast ( FACT-B ) ) , cytokines ( C-reactive protein ( CRP ) , TNF-α , IL-6 ) , and adipokine profile ( leptin , adiponectin , insulin ) . Results Participants in the program  lost more body fat ( 2.4 % loss vs. 0.4 % gain , p < 0.05 ) than the control group . The intervention group also improved quality of life ( FACT-B total score + 14 pts ) and decreased sedentary time but did not improve peak exercise capacity . The intervention had no effect on serum cytokines and adipokines after 12 weeks in the program . However , serum leptin and adiponectin and their ratio were significantly correlated with BMI in the intervention group ( p < 0.05 ) . Conclusions Exercise and dietary counseling led to loss of body fat and improved quality of life in survivors of triple-negative breast cancer . BMI was associated with favorable changes in leptin and adiponectin which may reflect a change in adiposity with intervention . Exercise and healthy eating may be equally effective in this high-risk population as in other breast cancer survivors and should be encouraged as a part of a cancer survivorship program Purpose African American women with breast cancer have higher cancer-specific and overall mortality rates . Obesity is common among African American women and contributes to breast cancer progression and numerous chronic conditions . Weight loss interventions among breast cancer survivors positively affect weight , behavior , biomarkers , and psychosocial outcomes , yet few target African Americans . This article examines the effects of Moving Forward , a weight loss intervention for African American breast cancer survivors ( AABCS ) on weight , body composition , and behavior . Patients and Methods Early-stage ( I-III ) AABCS were r and omly assigned to a 6-month interventionist-guided ( n = 125 ) or self-guided ( n = 121 ) weight loss program supporting behavioral changes to promote a 5 % weight loss .  Anthropometric , body composition , and behavioral data were collected at baseline , postintervention ( 6 months ) , and follow-up ( 12 months ) . Descriptive statistics and mixed models analyses assessed differences between groups over time . Results Mean ( ± st and ard deviation ) age , and body mass index were 57.5 ( ± 10.1 ) years and 36.1 ( ± 6.2 ) kg/m2 , respectively , and 82 % had stage I or II breast cancer . Both groups lost weight . Mean and percentage of weight loss were greater in the guided versus self-guided group ( at 6 months : 3.5 kg v 1.3 kg ; P < .001 ; 3.6 % v 1.4 % ; P < .001 , respectively ; at 12 months : 2.7 kg v 1.6 kg ; P < .05 ; 2.6 % v 1.6 % ; P < .05 , respectively ) ; 44 % in the guided group and 19 % in the self-guided group met the 5 % goal . Body composition and behavioral changes were also greater in the interventionist-guided group at both time points . Conclusion The study supports the efficacy of a community-based interventionist-guided weight loss program targeting AABCS .  Although mean weight loss did not reach the targeted 5 % , the mean loss of > 3 % at 6 months is associated with improved health outcomes . Affordable , accessible health promotion programs represent a critical re source for AABCS African-American ( AA ) women have higher rates of breast cancer ( BCa ) mortality than Caucasian women , and a recent study using data from the Surveillance , Epidemiology and End Results ( SEER ) registry suggests that this disparity may be due , in part , to the poorer health status of AAs at diagnosis and not treatment related issues . R and omized controlled trials involving supervised aerobic and resistance exercise have shown improved body composition and improvement in cancer-related biomarkers in BCa patients and may lead to improved recurrence and survival rates ; however , most trials have focused on Caucasians and many have been conducted in academic- and clinic-based setting s. We evaluated the feasibility of conducting a 20-week , supervised , resistance training , group exercise intervention coupled with a support group and home walking program utilizing facilities and personnel at a community cancer support center ( The Gathering Place , Beachwood , Ohio ) in AA Stage I-III BCa survivors who were within 12 months of completing treatment ( surgery , chemotherapy , and /or breast irradiation )  ; and , evaluated the potential effects of this intervention on physical measures and cancer-related biomarkers . 27 patients provided informed consent and 19 participated in the program . On average , attendance rates were 70.0 % ± 19.1 % for the exercise sessions and 63.1 % ± 13.8 % for the support group . We observed a significant decrease in circulating C-peptide levels ( B : 893.9 ± 399.1 pg/mL ; EOI : 723.9 ± 319.0 pg/mL ; p=0.01 ) . Although we did not observe a significant decrease in weight in the entire sample , there was a significant decrease in waist circumference and percent total body fat among those who attended 70 % or more of the exercise sessions . In summary , we demonstrated that conducting lifestyle interventions in AA BCa survivors in a community setting is feasible . Future interventions should invoke strategies to enhance adherence and include a structured dietary intervention to enable greater weight loss OBJECTIVE To evaluate whether the evidence -based Body & Soul program , when disseminated and implemented without research er or agency involvement and support , would achieve results similar to those of earlier efficacy and effectiveness trials . DESIGN Prospect i ve group r and omized trial . SETTING Churches with predominantly African American membership . PARTICIPANTS A total of 1,033 members from the 15 churches completed baseline surveys . Of these participants , 562 ( 54.4 % ) completed the follow-up survey 6 months later . INTERVENTION Church-based nutrition program for African Americans that included pastoral involvement , educational activities , church environmental changes , and peer counseling . MAIN OUTCOME MEASURE Daily fruit and vegetable ( FV ) intake was assessed at pre- and posttest . ANALYSIS Mixed-effects linear models . RESULTS At posttest , there was no statistically significant difference in daily servings of FVs between the early intervention group participants compared to control group participants ( 4.7 vs 4.4 , P = .38 ) . Process evaluation suggested that added re sources such as technical assistance could improve program implementation . CONCLUSIONS AND IMPLICATION S The disseminated program may not produce improvements in FV intake equal to those in the earlier efficacy and effectiveness trials , primarily because of a lack of program implementation . Program dissemination may not achieve public health impact unless support systems are strengthened for adequate implementation at the church level PURPOSE Obesity is associated with a higher risk of breast cancer mortality . The gold st and ard approach to weight loss is in-person counseling , but telephone counseling may be more feasible . We examined the effect of in-person versus telephone weight loss counseling versus usual care on 6-month changes in body composition , physical activity , diet , and serum biomarkers . METHODS One hundred breast cancer survivors with a body mass index ≥ 25 kg/m(2 ) were r and omly assigned to in-person counseling  ( n = 33 ) , telephone counseling ( n = 34 ) , or usual care ( UC ) ( n = 33 ) . In-person and telephone counseling included 11 30-minute counseling sessions over 6 months . These focused on reducing caloric intake , increasing physical activity , and behavioral therapy . Body composition , physical activity , diet , and serum biomarkers were measured at baseline and 6 months . RESULTS The mean age of participants was 59 ± 7.5 years old , with a mean BMI of 33.1 ± 6.6 kg/m(2 ) , and the mean time from diagnosis was 2.9 ± 2.1 years . Fifty-one percent of the participants had stage I breast cancer . Average 6-month weight loss was 6.4 % , 5.4 % , and 2.0 % for in-person , telephone , and UC groups , respectively ( P = .004 , P = .009 , and P = .46 comparing in-person with UC , telephone with UC , and in-person with telephone , respectively ) . A significant 30 % decrease in C-reactive protein levels was observed among women r and omly assigned to the combined weight loss intervention groups compared with a 1 % decrease among women r and omly assigned to UC ( P = .05 ) . CONCLUSION Both in-person and telephone counseling were effective weight loss strategies , with favorable effects on C-reactive protein levels . Our findings may help guide the incorporation of weight loss counseling into breast cancer treatment and care PURPOSE There is little prior study of major dietary patterns and breast cancer survival . METHODS Patients included 2,619 Nurses ' Health Study participants who were diagnosed with invasive breast cancer between 1982 and 1998 and completed a dietary question naire more than 1 year after diagnosis . Participants were followed through 2002 ( median = 9 years ) . During follow-up , 414 patients died of any cause , 242 patients died of breast cancer , and 172 patients died from causes other than breast cancer . Women with in situ or metastatic disease at diagnosis were excluded . We used Cox proportional hazards models to evaluate prospect i ve associations of prudent and Western dietary patterns assessed both before and after diagnosis with time to event after diagnosis . RESULTS In multivariate-adjusted analyses assessed after diagnosis , the Western and prudent dietary patterns were unrelated to all-cause or breast cancer mortality . However , compared with women with the lowest intake of the prudent dietary pattern , the relative risks ( and 95 % CIs ) of death from causes other than breast cancer were 0.85 ( 95 % CI , 0.53 to 1.35 ) , 0.74 ( 95 % CI , 0.45 to 1.21 ) , 0.70 ( 95 % CI , 0.42 to 1.17 ) , and 0.54 ( 95 % CI , 0.31 to 0.95 ; P = .03 , from lowest to highest quintile of intake ) . In contrast , the Western dietary pattern was positively associated with this outcome ( P = .04 ) . Results for the assessment of dietary patterns before diagnosis were similar , except the prudent dietary pattern was unrelated to mortality . CONCLUSION A higher intake of the prudent pattern and a lower intake of the Western pattern may protect against mortality from causes unrelated to breast cancer BACKGROUND Pre clinical and observational studies suggest a relationship between dietary fat intake and breast cancer , but the association remains controversial . We carried out a r and omized , prospect i ve , multicenter clinical trial to test the effect of a dietary intervention design ed to reduce fat intake in women with resected , early-stage breast cancer receiving conventional cancer management . METHODS A total of 2437 women were r and omly assigned between February 1994 and January 2001 in a ratio of 40:60 to dietary intervention ( n = 975 ) or control ( n = 1462 ) groups . An interim analysis was performed after a median follow-up of 60 months when funding for the intervention ceased . Mean differences between dietary intervention and control groups in nutrient intakes and anthropometric variables were compared with t tests . Relapse-free survival was examined using Kaplan-Meier analysis , stratified log-rank tests , and Cox proportional hazards models . Statistical tests were two-sided . RESULTS Dietary fat intake was lower in the intervention than in the control group ( fat grams/day at 12 months , 33.3 [ 95 % confidence interval { CI } = 32.2 to 34.5 ] versus 51.3 [ 95 % CI = 50.0 to 52.7 ] , respectively ; P<.001 ) , corresponding to a statistically significant ( P = .005 ) , 6-pound lower mean body weight in the intervention group . A total of 277 relapse events ( local , regional , distant , or ipsilateral breast cancer recurrence or new contralateral breast cancer ) have been reported in 96 of 975 ( 9.8 % ) women in the dietary group and 181 of 1462 ( 12.4 % ) women in the control group . The hazard ratio of relapse events in the intervention group compared with the control group was 0.76 ( 95 % CI = 0.60 to 0.98 , P = .077 for stratified log rank and P = .034 for adjusted Cox model analysis ) . Exploratory analyses suggested a differential effect of the dietary  intervention based on hormonal receptor status . CONCLUSIONS A lifestyle intervention reducing dietary fat intake , with modest influence on body weight , may improve relapse-free survival of breast cancer patients receiving conventional cancer management . Longer , ongoing nonintervention follow-up will address original protocol design plans , which called for 3 years of follow-up after completion of recruitment Purpose This study evaluated the feasibility and preliminary efficacy of two 6-month , self-regulation interventions that focused on daily self-weighing ( DSW ) and used objective monitoring and tailored feedback about weight ( ±activity ) , to prevent weight gain among African American breast cancer survivors . Methods Participants ( n = 35 ) were r and omized to an intervention + activity monitoring ( INT+ ) , intervention ( INT ) , or control ( CON ) group . Interventions included a wireless scale ( ±activity tracker ) that transmitted objective data to a mobile app/website , emailed lessons , and tailored feedback based on objective weight ( ±activity data ) . Participants completed in-person and online assessment s at baseline , 3 months , and 6 months . Results Ninety-four percent of participants completed assessment s at 3 months , and 97 % at 6 months . Median ( IQR ) weight change after 6 months was −0.9 % ( −4.4–0.1 ) in the INT+ ( p = 0.075 ; p = 0.067 vs. CON ) and −0.2 % ( −4.2–1.3 ) in the INT groups ( p = 0.463 ; p = 0.357 vs. CON ) , versus a 0.2 % ( −0.7–1.7 ) gain in the CON group . The proportion of INT+ , INT , and CON participants that were at or below baseline weight was 72.7 , 53.8 , and 45.5 % , respectively ( effect sizes d = 0.64 , d = 0.18 ) . Most INT+ participants weighed and wore trackers ≥5 days/week ( INT+ , 81.9 % vs. INT , 38.5 % vs. CON , 0 % ; p < 0.0005 ; INT+ , 72.7 % ) . Both intervention groups perceived DSW as positive , and 100 % would recommend the program to other breast cancer survivors . Conclusion An intervention focused on DSW as a self-monitoring strategy shows promise for preventing weight gain in breast cancer survivors . Implication s for cancer survivorsDaily self-monitoring of weight and activity may be a feasible and accessible approach to promote weight gain prevention in breast cancer survivors . Clinical trial registration Clinical Trials.gov , Previous findings suggest that exercise is a safe and efficacious means of improving physiological and psychosocial outcomes in female breast cancer survivors . To date , most research has focused on post-treatment interventions . However , given that the type and severity of treatment-related adverse effects may be dependent on the type of treatment , and that the effects are substantially more pronounced during treatment , an assessment of the safety and efficacy of exercise during treatment is warranted . In this review , we present and evaluate the results of r and omized controlled trials ( RCTs ) conducted during breast cancer treatment . We conducted literature search es to identify studies examining exercise interventions in breast cancer patients who were undergoing chemotherapy or radiation .  Data were extracted on physiological and psychosocial outcomes . Cohen 's d effect sizes were calculated for each outcome . A total of 17 studies involving 1,175 participants undergoing active cancer therapy met the inclusion criteria . Findings revealed that , on average , exercise interventions result ed in moderate to large improvements in muscular strength : resistance exercise ( RE , 𝑑 = 0.86 ) , aerobic exercise  ( AE , 𝑑 = 0.55 ) , small to moderate improvements in cardiovascular functioning ( RE , 𝑑 = 0.45 ; AE , 𝑑 = 0.17 , combination exercise ( COMB , 𝑑 = 0.31 ) and quality of life ( QoL ; RE , 𝑑 = 0.30 ; AE , 𝑑 = 0.50 ; COMB , 𝑑 = 0.63 ) . The results of this review suggest that exercise is a safe , feasible , and efficacious intervention in breast cancer patients who are undergoing different types of treatment . Additional research addressing the different modes of exercise during each type of treatment is warranted to assess the comparable efficacy of the various exercise modes during established breast cancer treatments Purpose The purpose of this study was to assess the feasibility , acceptability , and impact of a ballroom dance intervention on improving quality of life ( QOL ) and relationship outcomes in cancer survivors and their partners . Methods We conducted a pilot r and omized controlled trial with two arms ( Restoring Health in You ( and Your Partner ) through Movement , RHYTHM ) : ( 1 ) immediate dance intervention and ( 2 ) delayed intervention ( wait-list control ) . The intervention consisted of 10 private weekly dance lessons and 2 practice parties over 12 weeks . Main outcomes were physical activity ( Godin Leisure-Time Exercise Question naire ) , functional capacity ( 6 Minute Walk Test ) , QOL ( SF-36 ) , Couples ’ trust ( Dyadic Trust Scale ) , and other dyadic outcomes . Exit interviews were completed by all participating couples . Results Thirty-one women survivors ( 68 % breast cancer ) and their partners participated . Survivors were 57.9 years old on average and 22.6 % African American . Partners had similar characteristics . RHYTHM had significant positive effects on physical activity ( p = 0.05 ) , on the mental component of QOL ( p = 0.04 ) , on vitality ( p = 0.03 ) , and on the dyadic trust scale ( p = 0.04 ) . Couples expressed satisfaction with the intervention including appreciating the opportunity to spend time and exercise together . Survivors saw this light-intensity physical activity as easing them into becoming more physically active . Conclusions Light intensity ballroom dancing has the potential to improve cancer survivors ’ QOL . Larger trials are needed to build strong support for this ubiquitous and acceptable activity . Implication s for cancer survivorsBallroom dance may be an important tool for cancer survivors to return to a physically active life and improve QOL and other aspects of their intimate life PURPOSE To investigate the association between pre- and postdiagnosis physical activity ( as well as change in prediagnosis to postdiagnosis physical activity ) and mortality among women with breast cancer . PATIENTS AND METHODS This was a prospect i ve observational study of 933 women enrolled onto the Health , Eating , Activity , and Lifestyle Study who were diagnosed with local or regional breast cancer between 1995 and 1998 and observed until death or September 2004 , whichever came first . The primary outcomes measured were total deaths and breast cancer deaths . The primary exposures were  physical activity in the year before and 2 years after diagnosis and the pre- to postdiagnosis change in physical activity . RESULTS Compared with inactive women , the multivariable hazard ratios ( HRs ) for total deaths for women expending at least 9 metabolic equivalent hours per week ( approximately 2 to 3 h/wk of brisk walking ) were 0.69 ( 95 % CI , 0.45 to 1.06 ; P = .045 ) for those active in the year before diagnosis and 0.33 ( 95 % CI , 0.15 to 0.73 ; P = .046 ) for those active 2 years after diagnosis . Compared with women who were inactive both before and after diagnosis , women who increased physical activity  after diagnosis had a 45 % lower risk of death ( HR = 0.55 ; 95 % CI , 0.22 to 1.38 ) , and women who decreased physical activity  after diagnosis had a four-fold greater risk of death ( HR = 3.95 ; 95 % CI , 1.45 to 10.50 ) . CONCLUSION Moderate-intensity physical activity after a diagnosis of breast cancer may improve prognosis BACKGROUND Cancer survivors suffer from long-term adverse effects that reduce health-related quality of life ( QOL ) and physical functioning , creating an urgent need to develop effective , durable , and disseminable interventions . Harvest for Health , a home-based vegetable gardening intervention , holds promise for these domains . METHODS This report describes the methods and recruitment experiences from two r and omized controlled feasibility trials that employ a waitlist-controlled design . Delivered in partnership with Cooperative Extension Master Gardeners , this intervention provides one-on-one mentorship of cancer survivors in planning and maintaining three seasonal vegetable gardens over 12months . The primary aim is to determine intervention feasibility and acceptability ; secondary aims are to explore effects on objective and subjective measures of diet , physical activity and function , and QOL and examine participant factors associated with potential effects . One trial is conducted exclusively among 82 female breast cancer survivors residing in the Birmingham , AL metropolitan area ( BBCS ) ; another broadly throughout Alabama among 46 older cancer survivors aged > 60 ( ASCS ) . RESULTS  Response rates were 32.6 % ( BBCS ) and 52.3 % ( ASCS ) . Both trials exceeded 80 % of their accrual target . Leading reasons for in eligibility were removal of > 10 lymph nodes ( lymphedema risk factor ) , lack of physician approval , and unwillingness to be r and omized to the waitlist . CONCLUSION To date , recruitment and implementation of Harvest for Health appears feasible . DISCUSSION Although both studies encountered recruitment challenges , lessons learned can inform future larger-scale studies . Vegetable gardening interventions are of interest to cancer survivors and may provide opportunities to gain life skills leading to improvements in overall health and QOL PURPOSE This study examines the impact of yoga , including physical poses , breathing , and meditation exercises , on quality of life ( QOL ) , fatigue , distressed mood , and spiritual well-being among a multiethnic sample of breast cancer patients . PATIENTS AND METHODS One hundred twenty-eight patients ( 42 % African American , 31 % Hispanic ) recruited from an urban cancer center were r and omly assigned ( 2:1 ratio ) to a 12-week yoga intervention ( n = 84 ) or a 12-week waitlist control group ( n = 44 ) . Changes in QOL ( eg , Functional Assessment of Cancer Therapy ) from before r and om assignment ( T1 ) to the 3-month follow-up ( T3 ) were examined ; predictors of adherence were also assessed . Nearly half of all patients were receiving medical treatment . RESULTS Regression analyses indicated that the control group had a greater decrease in social well-being compared with the intervention group after controlling for baseline social well-being and covariates ( P < .0001 ) . Secondary analyses of 71 patients not receiving chemotherapy during the intervention period indicated favorable outcomes for the intervention group compared with the control group in overall QOL ( P < .008 ) , emotional well-being ( P < .015 ) , social well-being ( P < .004 ) , spiritual well-being ( P < .009 ) , and distressed mood ( P < .031 ) . Sixty-nine percent of intervention participants attended classes ( mean number of classes attended by active class participants = 7.00 + /- 3.80 ) , with lower adherence associated with increased fatigue ( P < .001 ) , radiotherapy ( P < .0001 ) , younger age ( P < .008 ) , and no  antiestrogen therapy  ( P < .02 ) . CONCLUSION Despite limited adherence , this intent-to-treat analysis suggests that yoga is associated with beneficial effects on social functioning among a medically diverse sample of breast cancer survivors . Among patients not receiving chemotherapy , yoga appears to enhance emotional well-being and mood and may serve to buffer deterioration in both overall and specific domains of QOL AIMS AND BACKGROUND The DIANA ( Diet and And rogens)-5 study is a multi-institutional r and omized controlled trial of the effectiveness of a diet based on Mediterranean and macrobiotic recipes and principles , associated with moderate physical activity , in reducing additional breast cancer events in women with early stage invasive breast cancer at high risk of recurrence because of metabolic or endocrine milieu . The intervention is expected to reduce serum insulin and sex hormones , which were associated with breast prognosis in previous studies . METHODS Between 2008 and 2010 , the study r and omly assigned 1208 patients to an intensive diet and exercise intervention or to a comparison group , to be followed-up through 2015 . General lifestyle recommendations for the prevention of cancer are given to both groups , and the intervention group is being offered a comprehensive lifestyle intervention , including cooking classes , conferences , common meals and exercise sessions . Adherence assessment s occurred at baseline and at 12 months and are planned at 36 and 60 months . They include food frequency diaries , anthropometric measures , body fat distribution assessed with impedance scale , one week registration of physical activity with a multisensor arm-b and monitor , metabolic and endocrine blood parameters . Outcome breast cancer events are assessed through self report at semi annual meetings or telephone interview and are vali date d through medical record verification . RESULTS The r and omized groups were comparable for age ( 51.8 years ) , proportion of ER-negative tumors ( 22 % ) , axillary node metastasis ( 42 % ) , reproductive variables , tobacco smoking , blood pressure , anthropometric measurements and hormonal and metabolic parameters . CONCLUSIONS DIANA-5 has the potential to establish whether a Mediterranean-macrobiotic lifestyle may reduce breast cancer recurrences . We will assess evidence of effectiveness , first by comparing the incidence of additional breast cancer events ( local or distant recurrence , second ipsilateral or contralateral cancer ) in the intervention and in the control group , by an intention-to-treat analysis , and second by analyzing the incidence of breast cancer events in the total study population by compliance assessment score BACKGROUND Physical activity is positively associated with survival and quality of life among breast cancer survivors . Despite these benefits , the majority of breast cancer survivors are insufficiently active . The potential health benefits of reducing sedentary behaviour ( sitting time ) in this population have not been extensively investigated . The ACTIVATE Trial will evaluate the efficacy of an intervention that combines wearable technology ( the Garmin Vivofit2 ® ) with traditional behavioural change approaches to increase physical activity and reduce sedentary behaviour performed by breast cancer survivors . METHODS / DESIGN This r and omised controlled trial includes inactive , postmenopausal women diagnosed with stage I-III breast cancer who have completed their primary treatment . Participants are r and omly assigned to the primary intervention group ( Garmin Vivofit2 ® ; behavioural feedback and goal setting session ; and , five telephone-delivered health coaching sessions ) or to the wait-list control group . The primary intervention is delivered over a 12-week period . The second 12-week period comprises a maintenance phase for the primary intervention group , and an abridged intervention ( Garmin Vivofit2 ® only ) for the wait-list control group . Moderate- to vigorous-intensity physical activity ( MVPA ) and sedentary behaviour are assessed by accelerometry at baseline ( T1 ) , end of intervention ( T2 ) , and end of maintenance phase ( T3 ) . DISCUSSION The ACTIVATE Trial is one of the first studies to incorporate wearable technology into an intervention for cancer survivors . If the use of wearable technology ( in combination with behaviour change strategies , or alone ) proves efficacious , it may become an inexpensive and sustainable addition to the health promotion strategies available to health care providers in the cancer survivorship context . TRIAL REGISTRATION ACTRN12616000175471 The primary purpose of the current study was to determine prospect i ve associations of accelerometer‐assessed physical activity intensity and sedentary time with health‐related quality of life ( HRQOL ) indicators among survivors of breast cancer PURPOSE Obesity is associated with poor outcomes in women with operable breast cancer .  Lifestyle interventions ( LIs ) that help women reduce their weight may improve outcomes . PATIENTS AND METHODS We conducted a multicenter r and omized trial comparing mail-based delivery of general health information alone or combined with a 24-month st and ardized , telephone-based LI that included diet ( 500 to 1,000 kcal per day deficit ) and physical activity ( 150 to 200 minutes of moderate-intensity physical activity per week ) goals to achieve weight loss ( up to 10 % ) . Women receiving adjuvant letrozole for T1 - 3N0 - 3M0 breast cancer with a body mass index ( BMI ) ≥ 24 kg/m(2 ) were eligible . Weight was measured in the clinic , and self-report physical activity , quality -of-life ( QOL ) , and diet question naires were completed . The primary outcome was disease-free survival . Accrual was terminated at 338 of 2,150 planned patients because of loss of funding . RESULTS Mean weight loss was significantly ( P < .001 ) greater in the LI arm versus the comparison arm ( 4.3 v 0.6 kg or 5.3 % v 0.7 % at 6 months and 3.1 v 0.3 kg or 3.6 % v 0.4 % at 24 months ) and occurred consistently across strata ( BMI 24 to < 30 v ≥ 30 kg/m(2 ) ; prior v no prior adjuvant chemotherapy ) . Weight loss was greatest in those with higher baseline levels of moderate-intensity physical activity or improvement in QOL . Hospitalization rates and medical events were similar . CONCLUSION A telephone-based LI led to significant weight loss that was still evident at 24 months , without adverse effects on QOL , hospitalizations , or medical events . Adequately powered r and omized trials with cancer end points are needed
target: Conclusions : The available literature suggests that African American breast cancer survivors adhere to interventions of various modalities and are capable of making modest to significant changes .
background: Background : African American breast cancer survivors have a higher incidence of estrogen receptor negative and basal-like ( e.g. , triple negative ) tumors , placing them at greater risk for poorer survival when compared to women of other racial and ethnic groups .
  While access to equitable care , late disease stage at diagnosis , tumor biology , and sociodemographic characteristics contribute to health disparities , poor lifestyle characteristics ( i.e. , inactivity , obesity , and poor diet ) contribute equally to these disparities .
  Lifestyle interventions hold promise in shielding African American survivors from second cancers , comorbidities , and premature mortality , but they are often underrepresented in studies promoting positive behaviors .
  This review examined the available literature to document health behaviors and lifestyle intervention ( i.e. , obesity , physical activity , and sedentary behavior ) studies in African American breast cancer survivors .