Physical Activity for Adults in the Ontario Breast Screening Program

NCT ID: NCT06405568

Last Updated: 2024-12-11

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Clinical Phase

NA

Total Enrollment

200 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-02-01

Study Completion Date

2027-02-01

Brief Summary

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There is "strong" evidence that physical activity (PA) can reduce the risk of breast cancer, which is important for individuals at higher-than-average risk due to their family history or genetic susceptibility. PA can also enhance quality of life (QoL), fitness, and surrogate markers linked to cancer prognosis (e.g., weight). Despite this evidence, most individuals in this cohort are insufficiently active, meaning they do not meet Canadian recommendations of at least 150 minutes of PA each week. This study aims to develop materials that can help increase the number of adults at higher-than-average risk who meet PA recommendations, alongside improving QoL and body mass index (BMI; a measure of one's body weight-height ratio). Participants will include individuals assigned female at birth, aged 30-69 years, at high-risk of breast cancer registered in the Ontario Breast Screening Program who will be randomly assigned to receive (1) the intervention, which includes a copy of PA recommendations (Canadian Society for Exercise Physiology \[CSEP\] recommendations for adults plus content spotlighting PA benefits) plus a PA motivation package featuring three 20-minute online webinars (explaining PA benefits and how to get started), digitized PA materials (providing evidence-based tools to modify behaviour), and a digitized logbook (to track PA) or (2) only a copy of PA recommendations.

Detailed Description

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Considerable research (\>500 studies) has examined the association between physical (in)activity and cancer incidence. Reviews of observational studies have led to the conclusion that there is some evidence for a reduced risk of 11 different cancer sites when comparing the highest to the lowest levels of physical activity (PA). Specifically, there is "strong" evidence that PA reduces the risk of bladder, breast, colon, endometrial, esophageal adenocarcinoma, and gastric cancers. As a result, public health agencies (e.g., Public Health Agency of Canada) promote PA as an important part of a healthy lifestyle and note that regular PA can help to reduce the risk of premature death and chronic diseases including breast cancer. The Canadian Society for Exercise Physiology (CSEP; https://csepguidelines.ca/guidelines/adults-18-64/) published recommendations for adults (aged 18-64) that include: (a) performing at least 150 minutes of moderate-to-vigorous intensity PA each week (i.e., activities that get your heart beating faster), (b) performing muscle strengthening activities at least twice a week, (c) limiting time spent sitting or laying down to 8 hours or less a day, and (d) achieving good quality and consistent sleep (i.e., 7 to 9 hours, with consistent bed and wake-up times).

Efforts to promote PA in adults at higher-than-average risk for breast cancer (reflected by their enrollment in the Ontario Breast Screening Program), are critical to reduce their risk of breast cancer. Despite the effectiveness of PA recommendations delivered through health care providers (HCPs), most individuals do not receive them during routine care as HCPs report barriers to promoting PA (e.g., inadequate training, lack of time/knowledge). Research needs to focus on developing sustainable interventions that can be implemented broadly using distance-based approaches and available infrastructure (e.g., patient registries) without burdening HCPs to increase the consistency with which PA is promoted to adults at higher-than-average risk for breast cancer. Unlike self-guided PA interventions, supervised face-to-face PA interventions can be costly, unsustainable, and have limited ability to reach individuals unable (or unwilling) to travel to a facility where interventions are delivered. Thus, online interventions should be explored as a means to expand support to adults at higher-than-average risk for breast cancer, as a complement to offering PA recommendations. When self-guided, these interventions are easily scalable at a relatively low marginal cost per additional participant. When self-guided, these interventions are easily scalable at a relatively low marginal cost per additional participant, accessible, self-paced, and available around the clock. Accordingly, they are frequently valued for their accessibility and convenience. Additionally, as interventions incorporating behaviour change techniques, such as goal setting and problem-solving, show greater sustained PA levels post-intervention, it is critical to embed those evidence-based techniques and PA materials (e.g., printed materials, logbook, webinars and education sessions) into online interventions if they are to be effective.

Accordingly, this team of researchers and HCPs have partnered to develop and evaluate an intervention comprising of a copy of PA recommendations for adults (18-64 years) plus a motivation package (intervention arm) that can be implemented using a distance-based approach and sustained in the current healthcare system without burdening HCPs. This study aims to test the following hypothesis: the effects of the intervention on PA (primary outcome), quality of life (QoL) (secondary outcome), and body mass index (BMI; secondary outcome) in adults at high-risk of breast cancer will be greater in comparison to standard care plus a copy of PA recommendations for adults (control arm).

Conditions

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Breast Cancer Female Physical Inactivity

Keywords

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Healthcare providers Physical activity Breast cancer

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

The proposed study is a parallel-arm randomized controlled trial. Individuals enrolled in the Ontario Breast Screening Program for High-Risk Screening will be invited by mail to contact research staff who will obtain informed consent. Individuals who self-report engaging in \>150 minutes of moderate-to-vigorous intensity physical activity (PA) each week or a condition that makes it unsuitable for participation in this study (e.g., hypertension) will be excluded. Participants will receive a copy of PA recommendations plus a PA motivation package (intervention arm), or just a copy of PA recommendations (control arm); the control arm will receive the PA motivation package after study completion. All participants will complete primary (PA) and secondary (quality of life, BMI) outcome measures at baseline (pre-randomization) and after six weeks online. All outcomes will be analyzed according to intention-to-treat principles according to their randomized allocation and performed using SPSS.
Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Investigators
The randomization will be concealed to the investigators throughout the trial; the investigators will not take part in the assessments or intervention delivery. The randomization will be concealed to study staff and participants until informed consent and baseline data are obtained. Study staff will be unblinded to group allocation upon randomization to enable delivery of the intervention arm and control arm corresponding materials, whereas the randomization will remain concealed to participants. To support blinding, all participants will be informed they are being enrolled in a study investigating ways to promote PA and will be kept blind to the fact that the intervention arm receives more materials than the control arm, and thus all (including participants allocated to the control arm) will receive materials (i.e., a copy of PA recommendations). Moreover, we do not anticipate participants to have contact with participants of the other arm.

Study Groups

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Physical activity recommendations plus motivation package (Intervention Arm)

Participants randomized to the intervention arm will receive a package consisting of two components: (1) a copy of age-appropriate physical activity (PA) recommendations matching the Canadian Society of Exercise Physiology (CSEP) recommendations and spotlighting PA benefits, and (2) a PA motivation package including: (a) a link to a website to view three 20-minute webinars covering PA benefits (for cancer risk reduction, quality of life, and weight management) and how to get started using the digitized PA materials and logbook, (b) digitized PA materials containing information explaining and supporting PA recommendations, examples of easy and safe PA participation for all, and activity sheets on behaviour change tools for sustaining PA, and (c) a PA logbook with instructions on how to track PA and tips for increasing PA.

Group Type EXPERIMENTAL

Physical activity intervention

Intervention Type BEHAVIORAL

Participants will receive a copy of physical activity (PA) recommendations plus a PA motivation package - namely three 20-minute online webinars (explaining PA benefits and how to get started), digitized PA materials (integrating evidence-based behaviour change tools, and a digitized logbook (to track PA).

Standard care and physical activity recommendations (Control Arm)

Participants randomized to the control arm will receive standard care (medical consultations/monitoring at the discretion of each patient's care team) and be advised to continue regular daily living activities; physical activity (PA) restrictions will not be imposed. To facilitate trial retention and because contamination could occur as control arm participants' care team may recommend PA as part of their practice, participants will receive a copy of age-appropriate PA recommendations matching the Canadian Society of Exercise Physiology (CSEP) recommendations and spotlighting PA benefits. This further helps to mitigate the risk that knowledge of which arm a participant has been allocated to leads to moral demoralization in control arm participants. The control arm participants will receive the PA motivation package post-study completion to encourage study completion.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Physical activity intervention

Participants will receive a copy of physical activity (PA) recommendations plus a PA motivation package - namely three 20-minute online webinars (explaining PA benefits and how to get started), digitized PA materials (integrating evidence-based behaviour change tools, and a digitized logbook (to track PA).

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* English- and French-speaking adults enrolled in the Ontario Breast Screening Program;
* Aged 30-69 years;
* Assigned female at birth;
* Be at high risk for breast cancer as identified through Category A or B, after genetic assessment: (a) Category A individuals meet ≥1 of the following criteria: (i) known carrier of a gene mutation (e.g., BRCA1, BRCA2), (ii) first degree relative of a carrier of a gene mutation (e.g., BRCA1, BRCA2), received genetic counselling but declined genetic testing, (iii) previously assessed as having ≥25% lifetime risk of breast cancer on basis of family history, or (iv) received chest radiation before age 30 and ≥ 8 years previously.

(b) Category B individuals meet ≥1 of the following criteria: (i) first degree relative of a carrier of a gene mutation (e.g., BRCA1, BRCA2), has not had genetic counselling or testing, (ii) a personal or family history of ≥1 of the following: ≥2 cases of breast cancer and/or ovarian cancer in closely related blood relatives, bilateral breast cancer, both breast cancer and ovarian cancer in the same individual, breast cancer at age ≤35 years, invasive serous ovarian cancer, breast cancer and/or ovarian cancer in Ashkenazi Jewish families, an identified gene mutation (e.g., BRCA1, BRCA2) in any blood relative, male breast cancer.

Exclusion Criteria

Individuals self-reporting

* \>150 minutes of moderate-to-vigorous intensity physical activity in the past week;
* no access to an internet connected device;
* a condition preventing physical activity (e.g., uncontrolled hypertension)
Minimum Eligible Age

30 Years

Maximum Eligible Age

69 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

Yes

Sponsors

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Canadian Institutes of Health Research (CIHR)

OTHER_GOV

Sponsor Role collaborator

Canadian Cancer Society (CCS)

OTHER

Sponsor Role collaborator

University of Ottawa

OTHER

Sponsor Role lead

Responsible Party

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Jennifer Brunet

Full Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Jennifer Brunet, PhD

Role: PRINCIPAL_INVESTIGATOR

University of Ottawa

Central Contacts

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Julia Hussien, PhD

Role: CONTACT

Phone: 613-562-5800

Email: [email protected]

Jennifer Brunet, PhD

Role: CONTACT

Phone: 613-562-5800

Email: [email protected]

References

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Friedenreich CM, Ryder-Burbidge C, McNeil J. Physical activity, obesity and sedentary behavior in cancer etiology: epidemiologic evidence and biologic mechanisms. Mol Oncol. 2021 Mar;15(3):790-800. doi: 10.1002/1878-0261.12772. Epub 2020 Aug 18.

Reference Type BACKGROUND
PMID: 32741068 (View on PubMed)

McTiernan A, Friedenreich CM, Katzmarzyk PT, Powell KE, Macko R, Buchner D, Pescatello LS, Bloodgood B, Tennant B, Vaux-Bjerke A, George SM, Troiano RP, Piercy KL; 2018 PHYSICAL ACTIVITY GUIDELINES ADVISORY COMMITTEE*. Physical Activity in Cancer Prevention and Survival: A Systematic Review. Med Sci Sports Exerc. 2019 Jun;51(6):1252-1261. doi: 10.1249/MSS.0000000000001937.

Reference Type BACKGROUND
PMID: 31095082 (View on PubMed)

McTiernan A, Schwartz RS, Potter J, Bowen D. Exercise clinical trials in cancer prevention research: a call to action. Cancer Epidemiol Biomarkers Prev. 1999 Mar;8(3):201-7.

Reference Type BACKGROUND
PMID: 10090297 (View on PubMed)

Patel AV, Friedenreich CM, Moore SC, Hayes SC, Silver JK, Campbell KL, Winters-Stone K, Gerber LH, George SM, Fulton JE, Denlinger C, Morris GS, Hue T, Schmitz KH, Matthews CE. American College of Sports Medicine Roundtable Report on Physical Activity, Sedentary Behavior, and Cancer Prevention and Control. Med Sci Sports Exerc. 2019 Nov;51(11):2391-2402. doi: 10.1249/MSS.0000000000002117.

Reference Type BACKGROUND
PMID: 31626056 (View on PubMed)

Hebert ET, Caughy MO, Shuval K. Primary care providers' perceptions of physical activity counselling in a clinical setting: a systematic review. Br J Sports Med. 2012 Jul;46(9):625-31. doi: 10.1136/bjsports-2011-090734.

Reference Type BACKGROUND
PMID: 22711796 (View on PubMed)

Haines TP, Sinnamon P, Wetzig NG, Lehman M, Walpole E, Pratt T, Smith A. Multimodal exercise improves quality of life of women being treated for breast cancer, but at what cost? Randomized trial with economic evaluation. Breast Cancer Res Treat. 2010 Nov;124(1):163-75. doi: 10.1007/s10549-010-1126-2. Epub 2010 Aug 24.

Reference Type BACKGROUND
PMID: 20734132 (View on PubMed)

Ormel HL, van der Schoot GGF, Sluiter WJ, Jalving M, Gietema JA, Walenkamp AME. Predictors of adherence to exercise interventions during and after cancer treatment: A systematic review. Psychooncology. 2018 Mar;27(3):713-724. doi: 10.1002/pon.4612. Epub 2018 Jan 26.

Reference Type BACKGROUND
PMID: 29247584 (View on PubMed)

Sevick MA, Dunn AL, Morrow MS, Marcus BH, Chen GJ, Blair SN. Cost-effectiveness of lifestyle and structured exercise interventions in sedentary adults: results of project ACTIVE. Am J Prev Med. 2000 Jul;19(1):1-8. doi: 10.1016/s0749-3797(00)00154-9.

Reference Type BACKGROUND
PMID: 10865157 (View on PubMed)

Brunet J, Wurz A, Nader PA, Belanger M. A systematic review summarizing the effect of health care provider-delivered physical activity interventions on physical activity behaviour in cancer survivors. Patient Educ Couns. 2020 Jul;103(7):1287-1301. doi: 10.1016/j.pec.2020.02.002. Epub 2020 Feb 8.

Reference Type BACKGROUND
PMID: 32067858 (View on PubMed)

Godin G, Shephard RJ. A simple method to assess exercise behavior in the community. Can J Appl Sport Sci. 1985 Sep;10(3):141-6.

Reference Type BACKGROUND
PMID: 4053261 (View on PubMed)

Related Links

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http://www.pahealthpromolab.com

Physical Activity and Health Promotion Laboratory Official Website

Other Identifiers

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156827

Identifier Type: -

Identifier Source: org_study_id