Advertisement

Journal of Behavioral Medicine

, Volume 39, Issue 4, pp 551–559 | Cite as

Randomized trial of a phone- and web-based weight loss program for women at elevated breast cancer risk: the HELP study

  • Lisa Cadmus-BertramEmail author
  • Sandahl H. Nelson
  • Sheri Hartman
  • Ruth E. Patterson
  • Barbara A. Parker
  • John P. Pierce
Article

Abstract

Excess weight and physical inactivity are modifiable risk factors for breast cancer. Behavioral intervention is particularly important among women with an elevated risk profile. This trial tested an intervention that trained women to use a self-monitoring website to increase activity and lose weight. Women with BMI ≥27.5 kg/m2 at elevated breast cancer risk were randomized to the intervention (N = 71) or usual care (N = 34). The intervention group received telephone-based coaching and used web-based self-monitoring tools. At 6 months, significant weight loss was observed in the intervention group (4.7 % loss from starting weight; SD = 4.7 %) relative to usual care (0.4 % gain; SD = 3.0 %) (p < 0.0001). By 12 months, the intervention group had lost 3.7 % of weight (SD = 5.4 %), compared to 1.3 % (SD = 4.2) for usual care (p = 0.003). At 12 months, accelerometer-measured moderate-to-vigorous physical activity increased by 12 min/day (SD = 24) compared to no change in usual care (p = 0.04. In summary, this web- and phone-based approach produced modest but significant improvements in weight and physical activity for women at elevated breast cancer risk.

Keywords

Weight loss Breast cancer Internet Technology Self-monitoring Physical activity 

Notes

Acknowledgments

This study was funded by (a) the University of California (UC) Athena Breast Health Network, via the Safeway Foundation and University of California Office of the President, and (b) by a gift from Carol Vassiliadis and family. Dr. Cadmus-Bertram is supported by Grant K07CA178870 and Dr. Hartman by Grant K07CA181323, both from the National Cancer Institute.

Compliance with ethical standards

Conflict of interest

Lisa Cadmus-Bertram, Sandahl H. Nelson, Sheri Hartman, Ruth E. Patterson, Barbara A. Parker and John P. Pierce declare that they have no conflict of interest.

Human and animal rights and Informed consent

All procedures followed were in accordance with ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

References

  1. Abraham, C., & Michie, S. (2008). A taxonomy of behavior change techniques used in interventions. Health Psychology, 27, 379–387. doi: 10.1037/0278-6133.27.3.379 CrossRefPubMedGoogle Scholar
  2. Ahn, J., Schatzkin, A., Lacey, J. V, Jr, Albanes, D., Ballard-Barbash, R., Adams, K. F., et al. (2007). Adiposity, adult weight change, and postmenopausal breast cancer risk. Archives of Internal Medicine, 167, 2091–2102. doi: 10.1001/archinte.167.19.2091 CrossRefPubMedGoogle Scholar
  3. American Cancer Society. (2013). Breast cancer facts and figures 2013–2014. Atlanta: American Cancer Society Inc.Google Scholar
  4. Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ: Prentice Hall.Google Scholar
  5. Befort, C. A., Klemp, J. R., Austin, H. L., Perri, M. G., Schmitz, K. H., Sullivan, D. K., & Fabian, C. J. (2011). Outcomes of a weight loss intervention among rural breast cancer survivors. Breast Cancer Research and Treatment, 132, 631–639. doi: 10.1007/s10549-011-1922-3 CrossRefPubMedPubMedCentralGoogle Scholar
  6. Brenner, D. R. (2014). Cancer incidence due to excess body weight and leisure-time physical inactivity in Canada: Implications for prevention. Preventive Medicine, 66, 131–139. doi: 10.1016/j.ypmed.2014.06.018 CrossRefPubMedGoogle Scholar
  7. Cadmus-Bertram, L., Wang, J. B., Patterson, R. E., Newman, V. A., Parker, B. A., & Pierce, J. P. (2013). Web-based self-monitoring for weight loss among overweight/obese women at increased risk for breast cancer: The HELP pilot study. Psycho-Oncology, 22, 1821–1828. doi: 10.1002/pon.3219 CrossRefPubMedGoogle Scholar
  8. Carpenter, C. J. (2010). A meta-analysis of the effectiveness of health belief model variables in predicting behavior. Health Communication, 25, 661–669. doi: 10.1080/10410236.2010.521906 CrossRefPubMedGoogle Scholar
  9. Demark-Wahnefried, W., Morey, M. C., Sloane, R., Snyder, D. C., Miller, P. E., Hartman, T. J., & Cohen, H. J. (2012). Reach out to enhance wellness home-based diet-exercise intervention promotes reproducible and sustainable long-term improvements in health behaviors, body weight, and physical functioning in older, overweight/obese cancer survivors. Journal of Clinical Oncology, 30, 2354–2361. doi: 10.1200/JCO.2011.40.0895 CrossRefPubMedPubMedCentralGoogle Scholar
  10. Dombrowski, S. U., Knittle, K., Avenell, A., Araujo-Soares, V., & Sniehotta, F. F. (2014). Long term maintenance of weight loss with non-surgical interventions in obese adults: Systematic review and meta-analyses of randomised controlled trials. British Medical Journal, 348, g2646. doi: 10.1136/bmj.g2646 CrossRefPubMedPubMedCentralGoogle Scholar
  11. Freedson, P. S., Melanson, E., & Sirard, J. (1998). Calibration of the Computer Science and Applications, Inc. accelerometer. Medicine and Science in Sports and Exercise, 30, 777–781.CrossRefPubMedGoogle Scholar
  12. Friedenreich, C. M., Woolcott, C. G., McTiernan, A., Terry, T., Brant, R., Ballard-Barbash, R., et al. (2011). Adiposity changes after a 1-year aerobic exercise intervention among postmenopausal women: A randomized controlled trial. International Journal of Obesity (2005), 35, 427–435. doi: 10.1038/ijo.2010.147 CrossRefGoogle Scholar
  13. Gail, M. H., Brinton, L. A., Byar, D. P., Corle, D. K., Green, S. B., Schairer, C., & Mulvihill, J. J. (1989). Projecting individualized probabilities of developing breast cancer for white females who are being examined annually. Journal of the National Cancer Institute, 81, 1879–1886.CrossRefPubMedGoogle Scholar
  14. Gail, M. H., Costantino, J. P., Pee, D., Bondy, M., Newman, L., Selvan, M., & Bernstein, L. (2007). Projecting individualized absolute invasive breast cancer risk in African American women. Journal of the National Cancer Institute, 99, 1782–1792.CrossRefPubMedGoogle Scholar
  15. Greenlee, H. A., Crew, K. D., Mata, J. M., McKinley, P. S., Rundle, A. G., Zhang, W., & Hershman, D. L. (2013). A pilot randomized controlled trial of a commercial diet and exercise weight loss program in minority breast cancer survivors. Obesity (Silver Spring), 21, 65–76. doi: 10.1002/oby.20245 CrossRefGoogle Scholar
  16. Harvie, M., Cohen, H., Mason, C., Mercer, T., Malik, R., Adams, J., et al. (2010). Adherence to a diet and exercise weight loss intervention amongst women at increased risk of breast cancer. The Open Obesity Journal, 2, 71–80.Google Scholar
  17. Heo, M., Kabat, G. C., Strickler, H. D., Lin, J., Hou, L., Stefanick, M. L., et al. (2015). Optimal cutoffs of obesity measures in relation to cancer risk in postmenopausal women in the Women’s Health Initiative Study. Journal of Womens Health, 24, 218–227. doi: 10.1089/jwh.2014.4977 CrossRefGoogle Scholar
  18. Heshka, S., Anderson, J. W., Atkinson, R. L., Greenway, F. L., Hill, J. O., Phinney, S. D., et al. (2003). Weight loss with self-help compared with a structured commercial program: A randomized trial. Journal of the American Medical Association, 289, 1792–1798. doi: 10.1001/jama.289.14.1792 CrossRefPubMedGoogle Scholar
  19. Hutchesson, M. J., Rollo, M. E., Krukowski, R., Ells, L., Harvey, J., Morgan, P. J., & Collins, C. E. (2015). eHealth interventions for the prevention and treatment of overweight and obesity in adults: A systematic review with meta-analysis. Obesity Reviews, 16, 376–392. doi: 10.1111/obr.12268 CrossRefPubMedGoogle Scholar
  20. Jakicic, J. M., King, W. C., Gibbs, B. B., Rogers, R. J., Rickman, A. D., Davis, K. K., & Belle, S. H. (2015). Objective versus self-reported physical activity in overweight and obese young adults. J Physical Activity and Health,. doi: 10.1123/jpah.2014-0277 Google Scholar
  21. Jakicic, J. M., Marcus, B. H., Gallagher, K. I., Napolitano, M., & Lang, W. (2003). Effect of exercise duration and intensity on weight loss in overweight, sedentary women: A randomized trial. Journal of the American Medical Association, 290, 1323–1330. doi: 10.1001/jama.290.10.1323 CrossRefPubMedGoogle Scholar
  22. Johns, D. J., Hartmann-Boyce, J., Jebb, S. A., Aveyard, P., & Behavioural Weight Management Review, G. (2014). Diet or exercise interventions vs. combined behavioral weight management programs: A systematic review and meta-analysis of direct comparisons. Journal of the Academy of Nutrition and Dietetics, 114, 1557–1568. doi: 10.1016/j.jand.2014.07.005 CrossRefPubMedPubMedCentralGoogle Scholar
  23. Kokkinos, P., & Myers, J. (2010). Exercise and physical activity: Clinical outcomes and applications. Circulation, 122, 1637–1648. doi: 10.1161/CIRCULATIONAHA.110.94839 CrossRefPubMedGoogle Scholar
  24. Lee, I. M., Shiroma, E. J., Lobelo, F., Puska, P., Blair, S. N., Katzmarzyk, P. T., & Lancet Physical Activity Series Working, G. (2012). Effect of physical inactivity on major non-communicable diseases worldwide: An analysis of burden of disease and life expectancy. Lancet, 380, 219–229. doi: 10.1016/S0140-6736(12)61031-9 CrossRefPubMedPubMedCentralGoogle Scholar
  25. Lemon, S. C., Zapka, J. G., & Clemow, L. (2004). Health behavior change among women with recent familial diagnosis of breast cancer. Preventive Medicine, 39, 253–262. doi: 10.1016/j.ypmed.2004.03.039 CrossRefPubMedGoogle Scholar
  26. Levine, D. M., Savarimuthu, S., Squires, A., Nicholson, J., & Jay, M. (2015). Technology-assisted weight loss interventions in primary care: A systematic review. Journal of General Internal Medicine, 30, 107–117. doi: 10.1007/s11606-014-2987-6 CrossRefPubMedGoogle Scholar
  27. Linde, J. A., Jeffery, R. W., Crow, S. J., Brelje, K. L., Pacanowski, C. R., Gavin, K. L., & Smolenski, D. J. (2015). The Tracking Study: Description of a randomized controlled trial of variations on weight tracking frequency in a behavioral weight loss program. Contemporary Clinical Trials, 40, 199–211. doi: 10.1016/j.cct.2014.12.007 CrossRefPubMedGoogle Scholar
  28. Madlensky, L., Natarajan, L., Flatt, S. W., Faerber, S., Newman, V. A., & Pierce, J. P. (2008). Timing of dietary change in response to a telephone counseling intervention: Evidence from the WHEL study. Health Psychology, 27, 539–547. doi: 10.1037/0278-6133.27.5.539 CrossRefPubMedPubMedCentralGoogle Scholar
  29. Michie, S., Abraham, C., Whittington, C., McAteer, J., & Gupta, S. (2009). Effective techniques in healthy eating and physical activity interventions: A meta-regression. Health Psychology, 28, 690–701. doi: 10.1037/a0016136 CrossRefPubMedGoogle Scholar
  30. Michie, S., Ashford, S., Sniehotta, F. F., Dombrowski, S. U., Bishop, A., & French, D. P. (2011). A refined taxonomy of behaviour change techniques to help people change their physical activity and healthy eating behaviours: The CALO-RE taxonomy. Psychology & Health, 26, 1479–1498. doi: 10.1080/08870446.2010.540664 CrossRefGoogle Scholar
  31. Neuhouser, M. L., Aragaki, A. K., Prentice, R. L., Manson, J. E., Chlebowski, R., Carty, C. L., & Anderson, G. L. (2015). Overweight, obesity, and postmenopausal invasive breast cancer risk: A secondary analysis of the Women’s Health Initiative randomized clinical trials. JAMA Oncology, 1, 611–621. doi: 10.1001/jamaoncol.2015.1546 CrossRefPubMedGoogle Scholar
  32. Newman, V. A., Thomson, C. A., Rock, C. L., Flatt, S. W., Kealey, S., Bardwell, W. A., et al. (2005). Achieving substantial changes in eating behavior among women previously treated for breast cancer–an overview of the intervention. Journal of the American Dietetic Association, 105, 382–391. doi: 10.1016/j.jada.2004.12.008. (quiz 488).CrossRefPubMedGoogle Scholar
  33. Nicklas, B. J., Gaukstern, J. E., Beavers, K. M., Newman, J. C., Leng, X., & Rejeski, W. J. (2014). Self-monitoring of spontaneous physical activity and sedentary behavior to prevent weight regain in older adults. Obesity (Silver Spring), 22, 1406–1412. doi: 10.1002/oby.20732 CrossRefGoogle Scholar
  34. Patterson, R. E., Marinac, C. R., Natarajan, L., Hartman, S. J., Cadmus-Bertram, L., Flatt, S. W., & Kerr, J. (2015). Recruitment strategies, design, and participant characteristics in a trial of weight-loss and metformin in breast cancer survivors. Contemporary Clinical Trials,. doi: 10.1016/j.cct.2015.12.009 Google Scholar
  35. Peirson, L., Fitzpatrick-Lewis, D., Ciliska, D., Usman Ali, M., Raina, P., & Sherifali, D. (2015). Strategies for weight maintenance in adult populations treated for overweight and obesity: A systematic review and meta-analysis. CMAJ Open, 3, E47–E54. doi: 10.9778/cmajo.20140050 CrossRefPubMedPubMedCentralGoogle Scholar
  36. Peters, T. M., Moore, S. C., Gierach, G. L., Wareham, N. J., Ekelund, U., Hollenbeck, A. R., et al. (2009). Intensity and timing of physical activity in relation to postmenopausal breast cancer risk: The prospective NIH-AARP Diet and Health Study. BMC Cancer, 9, 349.CrossRefPubMedPubMedCentralGoogle Scholar
  37. Pierce, J. P., Newman, V. A., Flatt, S. W., Faerber, S., Rock, C. L., Natarajan, L., & Kealey, S. (2004). Telephone counseling intervention increases intakes of micronutrient- and phytochemical-rich vegetables, fruit and fiber in breast cancer survivors. Journal of Nutrition, 134, 452–458.PubMedGoogle Scholar
  38. Pierce, J. P., Newman, V. A., Natarajan, L., Flatt, S. W., Al-Delaimy, W. K., Caan, B. J., & Parker, B. A. (2007). Telephone counseling helps maintain long-term adherence to a high-vegetable dietary pattern. Journal of Nutrition, 137, 2291–2296.PubMedPubMedCentralGoogle Scholar
  39. Prichard, I., Lee, A., Hutchinson, A. D., & Wilson, C. (2015). Familial risk for lifestyle-related chronic diseases: Can family health history be used as a motivational tool to promote health behaviour in young adults? Health Promotion Journal of Australia, 26, 122–128. doi: 10.1071/HE14104 CrossRefPubMedGoogle Scholar
  40. Prince, S. A., Adamo, K. B., Hamel, M. E., Hardt, J., Connor Gorber, S., & Tremblay, M. (2008). A comparison of direct versus self-report measures for assessing physical activity in adults: A systematic review. International Journal of Behavioral Nutrition and Physical Activity, 5, 56. doi: 10.1186/1479-5868-5-56 CrossRefPubMedPubMedCentralGoogle Scholar
  41. Rock, C. L., Flatt, S. W., Byers, T. E., Colditz, G. A., Demark-Wahnefried, W., Ganz, P. A., & Wyatt, H. (2015). 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. Journal of Clinical Oncology, 33, 3169–3176. doi: 10.1200/JCO.2015.61.1095 CrossRefPubMedGoogle Scholar
  42. Silva, M. N., Vieira, P. N., Coutinho, S. R., Minderico, C. S., Matos, M. G., Sardinha, L. B., & Teixeira, P. J. (2010). Using self-determination theory to promote physical activity and weight control: A randomized controlled trial in women. Journal of Behavioral Medicine, 33, 110–122. doi: 10.1007/s10865-009-9239-y CrossRefPubMedGoogle Scholar
  43. Swift, D. L., Johannsen, N. M., Lavie, C. J., Earnest, C. P., & Church, T. S. (2014). The role of exercise and physical activity in weight loss and maintenance. Progress in Cardiovascular Diseases, 56, 441–447. doi: 10.1016/j.pcad.2013.09.012 CrossRefPubMedGoogle Scholar
  44. Tucker, L. A., Cook, A. J., Nokes, N. R., & Adams, T. B. (2008). Telephone-based diet and exercise coaching and a weight-loss supplement result in weight and fat loss in 120 men and women. American Journal of Health Promotion, 23, 121–129. doi: 10.4278/ajhp.07051646 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Lisa Cadmus-Bertram
    • 1
    Email author
  • Sandahl H. Nelson
    • 2
  • Sheri Hartman
    • 2
  • Ruth E. Patterson
    • 2
  • Barbara A. Parker
    • 3
  • John P. Pierce
    • 2
  1. 1.Department of KinesiologyUniversity of Wisconsin - MadisonMadisonUSA
  2. 2.Department of Family Medicine and Public Health, Moores UCSD Cancer CenterUniversity of California, San DiegoLa JollaUSA
  3. 3.Department of Medicine, Moores UCSD Cancer CenterUniversity of California, San DiegoLa JollaUSA

Personalised recommendations