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

Abstract

Background Children surviving acute lymphoblastic leukemia (ALL) are at increased risk for overweight and obesity over that of the general population. Whether a generic or tailored approach to weight management is needed for cancer survivors has yet to be tested. Procedure Thirty-eight youth 8–18 years with BMI≥85% who had survived ALL were recruited for a randomized clinical trial evaluating a weight management intervention (WMI) tailored for childhood ALL survivors (Fit4Life). Fit4Life recipients received a 4-month web, phone, and text message-delivered WMI tailored for cancer survivorship. Controls received a general WMI delivered via phone and mail. Assessments were performed at baseline and 4 months. Outcome data were analyzed according to assigned treatment condition over time. Results Most (80% (70%,100%) [median (IQR)]) of the assigned curriculum was received by Fit4Life participants as compared to 50% (40%,65%) among controls. Fit4Life recipients ≥14 years demonstrated less weight gain (p=0.05) and increased moderate-to-vigorous physical activity (p<0.01) while all Fit4Life recipients reported reduced negative mood (p<0.05) over time as compared to control counterparts. Conclusions We demonstrated acceptable feasibility of a WMI tailored for overweight and obese children surviving ALL utilizing a multimodal technology approach. Improved weight, weight-related behavior, and psychological outcomes were demonstrated among Fit4Life intervention as compared to youth receiving a generic WMI. Data from this pilot trial may be used to design a larger trial to determine whether youth of all ages also can derive a benefit from a cancer-survivor tailored WMI and whether short-term outcomes translate into improved long-term outcomes for childhood ALL survivors.

Strategies to promote regular exercise in adolescent and young adult cancer survivors

“…[33][34][35][36][37][38][39] No adverse events or perceived risks were reported in any of the studies regardless of intervention timing or treatment status, suggesting that exercise interventions are safe and appropriate from a medical standpoint for this population.…”

“…Careful readings of the 22 full manuscripts further reduced the field to nine studies that met all inclusion criteria. [33][34][35][36][37][38][39][40][41][42] Of these studies, six included adolescent survivors, two addressed young adult survivors only, and one included both young adult and adolescent survivors. Interventions were heterogeneous across study design (nonrandomized, noncontrolled versus randomized, controlled trial), sample sizes (range =10-251), ages (range =3-39 years of age), diagnoses (acute lymphoblastic leukemia [ALL], brain tumor, mixed diagnoses), and points of intervention (on-treatment, immediate postcompletion of treatment, long-term survivorship).…”

“…34,42 In conjunction with self-monitoring that allows AYAs to identify patterns of exercise and barriers to engagement, problem-solving skills training to generate solutions to identified barriers is also a well-supported strategy to improve health behavior engagement in several chronic illness groups. 63 Problem-solving skills training generally consists of the following components: defining the problem, generating alternative solutions, deciding on a solution, and implementing and evaluating the solution.…”

“…[33][34][35][36][37] All of the interventions demonstrating benefits employed two or more psychosocial strategies, including in vivo exercise training, psychoeducation, goal-setting, self-monitoring, behavioral reinforcement, or social support. Four of the interventions also involved trained interventionists to ensure participant adherence with the intervention, including a mix of supervised instruction and unsupervised exercise sessions allowing adolescents to practice learned skills at home.…”

“…33,34,36,37,40,41 Psychoeducation encompasses a broad range of activities that generally combine education regarding exercise and its relation to cancer survivorship with counseling to increase the likelihood of engagement in this behavior. Though psychoeducation alone does not generally result in behavior change, it can help provide important knowledge necessary for success.…”