Study protocol for the Exercising Together© trial: a randomized, controlled trial of partnered exercise for couples coping with cancer

Abstract

Background Most cancer survivors are married, and cancer strains the physical and mental health of each partner and their intimate relationship. We created a partnered strength training program, Exercising Together©, where the survivor and his/her partner exercise as a team in order to improve physical and mental health of both members of the couple as well as the quality of their relationship. We have not yet determined if Exercising Together© is similarly effective in couples coping with different types of cancer nor if training as a team has unique and added benefits over those derived from supervised group training and/or shared behavior change. The purpose of this study is to determine the unique benefits of Exercising Together© on physical, mental, and relational health in couples coping with breast, prostate, or colorectal cancer. Methods Survivors of prostate, breast and colorectal cancer (N = 294, 98 per cancer site) and their intimate, co-residing partners are recruited to participate in a single-blind, parallel group, randomized trial comparing three exercise groups that train twice per week for 6 months. Couples are randomized to one of three groups: (1) Exercising Together© where partners train as a team in a supervised group setting; (2) separate supervised group exercise classes for survivors or partners, respectively; (3) unsupervised home exercise program provided to each partner. The primary outcome is relationship quality (dyadic coping by the Dyadic Coping scale, emotional intimacy by the Dyadic Adjustment Scale, physical intimacy by the Physical Intimacy Behavior Scale, and symptom incongruence). Secondary outcomes are physical health (% body fat by DXA, serum fasting lipids (triglycerides, HDL, and LDL cholesterol), insulin resistance (HOMA-IR), resting blood pressure, C-reactive protein, TNF alpha, and physical functioning by the short Physical Performance Battery and SF-36) and mental health (depressive symptoms, anxiety, fear of recurrence) of each partner. Outcomes are collected at baseline, mid (3 months), post-intervention (6 months), and follow-up (12 months). Discussion Exercising Together© could shift the paradigm of survivorship care toward novel couple-based approaches that could optimize outcomes for each partner because their health is interdependent on each other and their relationship. Trial registration ClinicalTrials.govNCT03630354. Registered August 14, 2018

From Organizing Medicine to Cooking With More Leafy Greens: A Dyadic, Qualitative Analysis of How Older African American Couples Take Care of Each Other’s Health

“…Exercising together appeared especially beneficial for increasing husbands' desire to take care of their wives and wives' desire to take care of the marriage itself. Thus, the goal of increasing a sense of teamwork appeared to be successful across multiple domains of health management, consistent with findings documenting the individual and relational benefits of the Exercising Together ® program (Lyons & Lee, 20 20;Winters-Stone et al, 2021), which served as the basis of the current intervention. Future work should unpack how this sense of teamwork translates into different health promotion behaviors for different spouses.…”

“…All couples participated in the same 12-week walking (at least 3 days/week for at least 30 minutes/day) plus supervised total body resistance training (2 days/week) exercise intervention. Couples were randomly assigned to either the Exercised Separately group (partners engaged in the prescribed exercise activities as individuals) or the Exercised Together group (partners completed the exercise prescription together and received education adapted from the Exercising Together ® program (Winters-Stone et al, 2021). For a full study description, please see Hornbuckle et al (2021b).…”

“…It is also important to note that participating in an exercise intervention both together and as a couple will likely increase not only each partner’s exercise behaviors, but their awareness of each other’s efforts to support one another. Indeed, cancer patients who participated in a different couple-based exercise intervention, Exercising Together ® (Winters-Stone et al, 2021), from which the current study was partially adapted, perceived their partner as being more actively involved in their health post-intervention. Thus, we examined both how complementary spouses’ self-reported health management behaviors were (e.g., how they reported taking care of each other), and how aware the spouses were of each other’s health-promoting behaviors (e.g., how much they perceived their spouse was doing to take care of them).…”

Delivering exercise medicine to cancer survivors: has COVID-19 shifted the landscape for how and who can be reached with supervised group exercise?

“…We are currently conducting two randomized controlled trials of supervised, group exercise training in cancer survivors, all of whom were previously inactive and who are mostly older (Table 1 ). One trial (Study 1: NCT03630354) that aims to determine the benefits of partnered exercise in couples coping with cancer includes breast cancer survivors plus their spouse who are randomized to either one of two twice-weekly supervised group resistance training arms (one arm has couples train as a team in a group with other couples, and the other arm has separate survivor-only or spouse-only groups) or to individual home-based resistance training [ 14 ]. The other trial (Study 2: NCT03741335) that aims to compare the efficacy of different exercise programs to prevent falls associated with androgen deprivation therapy includes men with prostate cancer randomized to thrice-weekly supervised group resistance, tai chi, or flexibility training [ 15 ].…”

Adapting a dyadic exercise program to be culturally relevant for Hispanic men with prostate cancer using community engagement studio: a brief report

“…Importantly, recent evidence suggests that the inclusion of a cancer caregiver in interventions may better improve adherence to current guidelines and cancer outcomes ( Badr et al, 2019 ). Presently, few dyadic interventions exist for Hispanic cancer survivors and none aim to improve exercise behaviors tailored to Hispanic men with prostate cancer ( Rush et al, 2015 ; Cho et al, 2020 ; Badger et al, 2021 ; Crane et al, 2021 ; Winters-Stone et al, 2021a , b ).…”