Introduction
Methods
Literature search
Selection procedure
Data extraction
First author (year) Country | Study design | Sample characteristics | Dropout rate | Intervention duration; type (name) | Follow up after the end of the intervention | Mean baseline BMI and weight in kilograms (SD) | Mean weight change in kilograms (SD) [%weight change from baseline] | Remarks |
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Colorectal cancer survivors
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Anderson (2010) [41] UK | Single arm pretest-posttest |
N = 20 50% female Mean age: 61.1 (SD 9.0) 6–46 weeks postoperation | 10% | 3 months PA + diet (LiveWell) | No | BMI: 31.2 (5.4); no mean baseline body weight reported | −1.2 (4.4) (p value not mentioned) | Feasibility study; baseline weight not mentioned; weight is not a primary outcome. [% weight change cannot be calculated] |
Colorectal, breast and prostate cancer survivors
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Morey (2009) [42] USA | RCT, wait-list control |
N = 641 I: N = 319 DI: N = 322 I: 54.3% female DI: 56.3% female | I: 15.7% DI: 10.2% | 12 months PA + diet; (RENEW) | No | BMI: I: 29.1 (SE 0.2) DI: 29.2 (SE 0.2) Weight: I: 85.7 (SE 0.7) DI: 84.7 (SE 0.7) | 12 months vs. baseline: I: −2.06 (SE 0.19) [−2.40%] DI: −0.92 (SE 0.2) [−1.1%] I vs. DI*** | I = intervention; DI = delayed intervention, initiated at 12 months after baseline Physical function as primary outcome |
Demark-Wahnefried (2012) [43] USA | Mean age: I: 73.0 (SD 5.2) Mean age: DI: 72.9 (SD 5.0) Mean time since diagnosis: I: 8.7 (SD 2.8) years DI: 8.6 (SD 2.6) years | I: 24% DI: 24% | 12 months | 24 vs. 12 months: I: 0.25 (95% CI: −0.17; 0.67) NS [−2.61%] DI: −1.46 (95% CI: −1.97; −0.95)*** Weight 24 months vs. baseline: I: −2.24*** DI: −2.4*** | I vs. DI not assessed at 24 months; weight change between baseline and 24 months calculated | |||
Postmenopausal breast cancer survivors
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Befort (2012) [44] USA | Single arm pretest-posttest |
N = 34 100% female Mean age: 58.9 (SD 7.8) Mean time since treatment: 3.1 (SD 1.6) years | 9% | 6 months PA + diet | No | BMI: 34.1 (4.4) Weight: 89.8 (13.6) | −12.5 (5.8)*** [−13.9%] | Feasibility study; dropout: attended ≤75% of intervention sessions and completed posttreatment data collection visits |
Campbell (2012) [45] Canada | Single arm pretest-posttest |
N = 14 100% female Mean age: 54.6 (SD 8.3) Mean time since treatment: 24.1 (SD 21.5) months | 0% | 24 weeks PA + diet | 12 weeks | BMI: 30.1 (3.6) Weight: 78.8 (10.7) | 24 weeks vs. baseline: −3.8 (5.0)** [−4.82%] 36 vs. 24 weeks: −0.8 (1.2)* [−1.0%] 36 vs. baseline −4.6 kg [−5.84%] | Feasibility study |
Thompson (2015) [46] USA | 3-Arm non-randomized controlled trial |
N = 249 100% female Mean age: 54.9 (9.2) Time since treatment: ≥4 months LC: 81 LF: 93 C: 75 | LC: 18.5% LF: 21.5% C: 29.3% | 6 months Diet only | No | BMI: LC: 29.4 (2.5) LF: 28.2 (2.4) C: 29.2 (2.7) Weight: LC: 79.7 (8.6) LF: 77.6 (7.7) C: 79.7 (9.3) | 6 months vs. baseline: LC: −10.5 (−11.6; −9.3) [−13.2%] LF: −9.3 (−10.3; −8.3) [−12.0%] C: −0.4 (−1.0; 0.3) [−0.5%] LF vs. control*** LC vs. control*** | LF = low fat diet LC = low carbohydrate diet C = control Similar results described in Thompson et al. [47] |
Thomson (2010) [48] USA | RCT |
N = 43 LF: N = 22 LC: N = 21 100% female Mean age: 56.2 (SD 9.4) Mean time since diagnosis: 3.7 (3.4) years | 7.5% LF: 4.5% LC: 9.5% | 6 months Diet only | No | BMI: LC: 32.5 (4.7) LF: 31.0 (3.9) Weight: LC: 84.9 (14.0) LF: 83.1 (10.5) | 24 weeks vs. baseline: LC: −5.9 (4.1)*** [−6.95%] LF: −6.3 (5.6)*** [−7.58%] LC vs. LF NS | LF = low fat diet LC = low carbohydrate diet: modified Atkins/reduced carbohydrate diet |
De Waard (1993) [49] The Netherlands | RCT | Dutch sample:
N = 54 (I: 30; C: 24) Polish sample:
N = 48 (I: 29; C: 19) 100% female Age: 50–69 years Included directly after treatment | Dutch sample: 1 year I: 7%; C: 0% 3 years I: 40%; C: 37.5% Polish sample: 1 year I: 6.9%; C: 21.1% | 12 months Diet only | Dutch sample: 2 years Polish sample: No | No mean baseline body weight and BMI reported | Dutch sample: (3 years vs. baseline) I: median −6 C: median +1 I vs. C*** Polish sample: (1 year vs. baseline) I: median −6 C: median −1 I vs. C*** | Feasibility study; two samples: one Dutch and one Polish sample [% weight change cannot be calculated] |
Breast cancer survivors
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Demark-Wahnefried (2014) [50] USA | RCT |
N = 68 Individually tailored: 25 Team tailored: 25 Control: 18 100% female Mean age: 61.3 (7.4) Mean time since diagnosis: 24 (13) months | 7.4% Individual: 8% Team: 8% Control: 5.6% | 12 months PA + diet (DAMES) | No | BMI: Individual: 31.6 (3.4) Team: 30.8 (3.3) Control: 30.7 (2.6) Weight: Individual: 83.2 (8.8) Team: 82.6 (13.4) Control: 81.6 (9.3) | 12 months vs. baseline: Individual: −3.77 (4.80) [−4.5%] Team: −2.09 (4.30) [−2.5%] Control: −0.87 (2.97) [−1.1%] Team vs. control: NS Individual vs. control* | Feasibility study; groups consist of mother-daughter dyads; each comprised a survivor of breast cancer and her adult biological daughter. Only results for cancer survivors are reported here. |
Djuric (2009) [51] USA | RCT |
N = 31 enrolled; N = 24 randomized after 6 months 100% female Dietitian group: N = 12 Mean age: 56 (SD 10) Mean time since diagnosis: 5.6 (SD 4.3) years Spirituality group: N = 12 Mean age: 55 (SD 8) Mean time since diagnosis: 5.7 (SD 3.3) years | 8.4% at 18 months Dietitian group: 8.4% Spirituality group: 8.4% | 18 months PA + diet vs. PA + diet + spirituality counselling | No | BMI: Dietitian group: 36 (5) Spirituality group: 36 (3) Weight: Dietitian group: 94.9 (14.8) Spirituality group: 93.8 (11.3) | Dietitian group: 0–6 months: −2.6 (4.7) 6–18 months: +0.4 (3.0) 0–18 months: −2.2 [−2.32%] Spirituality group:0–6 months: −1.0 (7.0) 6–18 months: +0.3 (3.4) 0–18 months: −0.7 [−0.75%] Dietician only vs. dietician and spirituality 18 vs. 6 months: NS | Pilot-study; randomization after 6 months of PA + diet counselling (dietitian-led counselling); dietitian-led counselling vs. dietitian-led counselling + spirituality counselling
p Values for within-group changes are not reported. |
Flynn (2010) [52] USA | RCT |
N = 44 100% female Mean age: 59.2 (SD 6.1) Included within 4 years after completing treatment | 36.4% at 16 weeks; 54.5% at 16 weeks +6 months | 2 × 8 weeks Diet only: randomized diet + 6 months diet of choice | No | BMI: 27.9 (2.8); no mean baseline body weight reported | 16 weeks vs. baseline: NCI: −2.7 (1.4) [−3.9%] PBOO: −3.6 (1.9) [−4.9%] NCI vs. PBOO* Weight at 16 weeks + 6 m: 66.9 (8.7) Weight at 16 weeks: 68.0 (8.8) 16 weeks + 6 m vs. 16 weeks: p = 0.07% weight change was greater for NCI when NCI was consumed first and greater for PBOO when PBOO was consumed first, both***. | 2 × 8-week diet; random assignment of diet order + 6 months diet of choice NCI = National Cancer Institute Diet PBOO = Plant-based olive oil diet
p Values for within-group changes are not reported. |
Greenlee (2013) [53] USA | RCT, wait-list control |
N = 42 100% female IA: N = 22 Mean age: 52.6 (SD 8.0) Mean time since diagnosis: 3.5 (SD 2.1) years WCA: N = 20 Mean age: 48.6 (SD 9.6) Mean time since diagnosis: 4.7 (SD 3.2) years | IA: 4.5% WCA: 15% | 6 months PA + diet (Curves program) | 6 months | BMI: IA: 33.4 (6.6) WCA: 32.9 (5.2) Weight: IA: 85.1 (12.5) WCA: 83.8 (15.3) | 6 months vs. baseline: IA: −2.87 (3.15)*** [−3.37%] WCA: −1.42 (2.50)* [−1.69%] IA vs. WCA* 12 months vs. baseline: IA: −1.76 (3.21)* [−2.07%] WCA: −2.14 (3.77)* | IA = immediate arm: 6 month- intervention followed by 6 months of observation; WCA = wait-list control arm: 6 months of observation followed by 6 months of intervention. |
Harrigan (2015) [54] USA | RCT |
N = 100 In-person: 33 Telephone: 34 Usual care: 33 100% female Mean age: 59.0 (7.5) Mean time since diagnosis: 2.9 (2.1) years | 6 months: In-person: 9.1% Telephone: 29.4% Usual care: 6% 12 months: In-person: 33.3% Telephone: 55.9% Usual care: 42% | 6 months PA+ diet (LEAN) | 6 months* | BMI: In-person: 33.5 (6.7) Telephone: 31.8 (5.4) Usual care: 34.0 (7.5) Weight: In-person: 88.1 (18.3) Telephone: 84.3 (15.3) Usual care: 90.4 (20.3) | 6 months vs. baseline: In-person: −5.6 (−7.1; −4.1) [−6.4%] Telephone: −4.8 (−6.5; −3.1) [−5.7%] Usual care: −1.7 (−3.2; −0.3) [−1.9%] In-person vs. usual care:** Telephone vs. usual care:** In-person vs. telephone NS 12 months vs. baseline (self-reported) In-person: −5.6 (−8.0; −3.3) [−6.3%] Telephone: −6.3 (−9.9; −2.6) [−7.7%] Usual care: −3.8 (−5.6; −1.9) [−4.3%] In-person vs. usual care: NS Telephone vs. usual care: NS In-person vs. telephone: NS | In-person vs. telephone weight loss counselling vs. usual care. *6-month follow-up measurement of self-reported weight only*; weight was measured at baseline and directly after the end of the intervention. |
Jen (2004) [55] USA | RCT |
N = 48 C: N = 13 WW: N = 11 Ind: N = 13 Comp: N = 11 100% female Mean age: 51.7 (SD 8.4) Time since diagnosis: up to 4 years | 18.8% C = 7.7% WW = 27.3% Ind = 30.8% Comp = 9.1% | 12 months Diet only vs. diet and PA | No | BMI: C: 34.9 (SE 1.2) WW: 35 (SE1.2 ) Ind: 35.5 (SE 1.1) Comp: 36.8 (SE 1) Weight: C: 95.0 (SE 3.6) WW: 95.5 (SE 5) Ind: 91.4 (SE 2.7) Comp: 100.5 (SE 5) | 12 months vs. baseline: C: +1.1 (SE 1.7) [+1.2%] WW: −2.7 (SE 2.1) [−2.83%] Ind: −8.0 (SE 1.9)* [−8.75%] Comp: −9.5 (SE 2.7)* [−9.45%] Between-group effect:*** | Pilot study; C = control WW = weight watchers Ind = individualized Comp = comprehensive; Comprehensive group = both individualized counselling and weight watchers. Baseline values between groups NS. Similar results presented in Djuric et al. [56]. |
McTiernan (1998) [57] USA | Single arm pretest-posttest |
N = 10 100% female Age: 40–74 years 1–5 years posttreatment | 10% | 8 weeks PA + diet | No | BMI not mentioned 76.7 (SD not mentioned) | −1.18 (1.4)* [−1.54%] | Pilot study |
Mefferd (2007) [58] USA | RCT |
N = 85 100% female Mean time since diagnosis: 3.5 (SD 3.0) years I: N = 56 Mean age: 56 (SD 9) C: N = 29 Mean age: 56 (SD 8) | 10.6% 16.1% 0% | 16 weeks PA + diet | No | BMI: I: 30.7 (3.8) C: 31.3 (4.8) Weight: I: 83.9 (11.9) C: 86.3 (14.2) | 16 weeks vs. baseline: I: −5.7 [−6.79%] C: −0.5 [−0.6%] I vs. C* | Weight change calculated; no SD mentioned. This study has a wait-list control design. However, only results directly after the end of the intervention are described. Similar results are described in Pakiz et al. [59]. |
Patella (2009) [60] Italy | Single arm pretest-posttest |
N = 97 100% female Mean age: 57 (SD 9.9) Mean time since surgery in those diagnosed ≤5 years ago: 17.6 (SD 15.8) months; n = 76 Mean time since surgery in those diagnosed >5 years ago: 137.2 (SD 78.8) months; n = 16 | 22.8% | 12 months Diet only | No | BMI: 30.6 (4.2) Weight: 78.5 (9.7) | −6.6 (3.7)*** [−8.41%] | Study was originally designed as a two arm pretest-posttest study; due to much larger dropout rate in the control group (73.2%) compared with the Intervention group (22.8%), only pretest-posttest results of the intervention group are presented. |
Rock (2015) [61] USA | RCT |
N = 697 100% female I: 348 Mean age: 56 (9) Mean time since treatment: 2.02 (0.55) years C: 349 Mean age: 56 (9) Mean time since treatment: 2.18 (0.55) years | I: 13.8% C: 17.8% | 24 months PA + diet (ENERGY) | No | BMI: I: 31.6 (4.7) C: 31.4 (4.6) Weight: I: 85.0 (14.3) C: 84.7 (13.8) | 12 months vs. baseline: I: −5.3 [−6.0%] C: −1.2 [−1.5%] I vs. C*** 24 months vs. baseline: I: −3.6 [−3.7%] C: −0.9 [−1.3%] I vs. C*** | |
Saquib (2009) [62] USA | RCT |
N = 1760* 100% female C: N = 760* Mean age: 54.5 (SD 8.4) Mean time since diagnosis: 25.3 (SD 12.2) months I: N = 750* Mean age: 54.4 (SD 8.4) Mean time since diagnosis: 24.5 (SD 12.2) months | 14% | 4 years Diet only Women’s Healthy Eating and Living (WHEL) Study | No | BMI: I: 30.7 (4.8) C: 31.0 (5.5) Weight: I: <55 years: 83.7 ≥55 years: 81.0 C: <55 years: 83.2 ≥55 years: 82.7 | I: <55: year 1: −0.1; year 2 or 3: +1.5; year 4: +1.9 year 4 vs. baseline: [+2.27%] ≥55: year: −0.7; year 2 or 3: +0.2; year 4: +0.5 year 4 vs. baseline: [+0.62%] C: <55: year 1: +0.8; year 2 or 3: +1.6; year 4: +1.6 year 4 vs. baseline: [+1.92%] ≥55: year 1: −0.3; year 2 or 3: −0.4; year 4: −0.6 year 4 vs. baseline: [−0.73%] NS difference in mean body weight between the groups either at baseline or at follow-up. Weight change difference I vs. C*** in year 1 only | *Subgroup analyses of 1510 participants in the WHEL Study: overweight and obese participants (BMI ≥ 25) only; results for weight are stratified for age. Weight is not a primary outcome. No statistically significant difference in weight between intervention and control directly after intervention completion. |
Sheppard (2016) [63] USA | RCT |
N = 31 I: 15 C: 16 100% female Mean age: 54.7 (9.8) Mean time since treatment: 1.7 (0.88) years | I: 25% C: 33.3% | 12 weeks PA + diet (Stepping STONE) | No | BMI: I: 35.2 (4.8) C: 37.4 (8.6) Weight: I: 98.2 (19.5) C: 97.8 (21.1) | 12 weeks vs. baseline: I: −0.77 [−0.78%] C: + 0.18 [+0.18%]
p Value I vs. C not mentioned | Feasibility study; this study has a wait-list control design. However, only results directly after the end of the intervention are described. |
Spark (2015) [64] Australia | Single arm pretest-posttest |
N = 29 100% female Mean age: 54.9 (8.8) Mean time since treatment: 7.1 (1.4) months | 21% | 6-month intervention + 6 month-extended intervention PA +diet | 6 months | BMI: 30.0 (4.2) Weight: 81.8 (13.1) | 6 months vs. baseline: −5.5* [−6.7%] 12 months vs. baseline: −4.2* [−5.1%] 18 months vs. baseline: −4.2 (−6.0; −2.4)* [−5.1%] 12 vs. 6 months: + 1.3 (−0.5; 3.1) NS [+1.6%] 18 vs. 12 months: −0.1 (−1.9; 1.8) NS [−0.1%] | Feasibility study; 6-month extended contact intervention after the original 6-month PA + diet intervention. |
Stolley (2009) [65] USA | Single arm pretest-posttest |
N = 23 100% female Mean age: 51.4 (SD 8.9) Time since treatment: ≥6 months | 13% | 6 months PA +diet (Moving Forward) | No | BMI: 34.1 (95% CI 30.8; 37.4) Weight: 87.8 (95% CI 79.2;96.3) | −2.53 (−3.91; −1.14)*** [−2.88%] | |
Swisher (2015) [66] USA | RCT |
N = 28 100% female Mean time since diagnosis: 4–5 years I: 18 Mean age: 53.8 C: 10 Mean age: 53.6 | I: 27.8% C: 0% | 12 weeks PA + diet (Get Fit for the Fight) | No | BMI: I: 30.9 (3.3) C: 32.5 (7.1) Weight: I: 80.2 (9.6) C: 85.4 (21.4) | 12 weeks vs. baseline: I: −3.0 [−3.7%]* C: −0.4 [−0.5%] | I vs. C: % body fat* |
Travier (2014) [67] Spain | Single arm pretest-posttest |
N = 42 100% female Mean age: 54.8 (SD 8.7) Mean time since treatment: 87.6 (SD 62.9) days | 12% | 12 weeks PA + diet | No | BMI: 30.5 (3.9) Weight: 73.3 (10.2) | −7.8 (2.9)*** [−10.6%] | Feasibility study; similar results are presented in Travier et al. [68] |
Vitolins (2014) [69] USA | Single arm pretest-posttest |
N = 19 100% female Median age (range): 59 (38–72) Time since treatment: ≥6 months | 10.5% | 12 weeks PA + diet | No | BMI: Median 31.3 Weight: 88.0 (18.3) | −6.3 (3.6)*** [−7.16%] | Feasibility study |
Breast and endometrial cancer survivors
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McCarroll (2015) [70] USA | Single arm pretest-posttest |
N = 50 100% female Mean age: 58.4 (10.3) Time since treatment: ≥ 6 months | 15% | 1 month (Lose It!) PA + diet | No | BMI: 36.4 (8.1) Weight: 97.3 (22.5) | −2.3*** [−2.4%] | Feasibility study |
Endometrial cancer survivors
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Von Gruenigen (2008) [71] USA | RCT |
N = 45 100% female I: N = 23 Mean age: 54 (2.0) Time since diagnosis: median 20.6 months C: N = 22 Mean age: 55.5 (1.6) Time since diagnosis: median 26.7 months | I: 22% C: 10% | 6 months PA + diet | 6 months | BMI: I: 43.5 (SE 2.1) C: 41.1 (SE 2.2) Weight: I: 115.4 (29.4)C: 107.1 (24.7) | I: 3 months vs. baseline: −2.6 (95% CI: −1.0 to −4.2), p = 0.001 6 vs. 3 months: −0.3 (95% CI: −1.1 to 1.8) NS 12 vs. 6 months: −0.3 (95% CI: −2.8 to 3.3) NS 6 months vs. baseline: −2.9 kg [−2.51%] C: no significant weight changes from baseline 12 months vs. baseline: I: −3.5 [−3.03%] C: +1.4[+1.3%] I vs. C: −4.9 (95% CI −9.0, −0.9)* | |
Von Gruenigen (2012) [72] USA | RCT |
N = 75 100% female I: N = 41 Mean age: 57.0 (SD 8.6) Time since diagnosis: median 17.6 months (range: 5.5–36.0) C: N = 34 Mean age: 58.9 (SD 10.9) Time since diagnosis: median 25.5 months (range 4.4–36.0) | I: 14.6% C: 29.4% | 6 months PA + diet (SUCCEED) | 6 months | BMI: I: 36.4 (5.5) C: 36.5 (9.6) Weight: I: 95.7 (19.0) C: 94.0 (23.0) | 6 months vs. baseline: I: −3.9 [−4.08%] C: +0.6 [+0.64%] I vs. C*** 12 months vs. baseline: I: −3.0 [−3.13%] C: +1.4 [+1.49%] I vs. C*** |
First author (year), country | Intervention aims and componentsa
| Control condition | Theoretical framework | Behaviour change techniquesb
|
---|---|---|---|---|
Colorectal, breast and prostate cancer survivors
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Morey (2009) [42] UK |
Aims: weight loss goal of 10% during the 12-month study period; restriction of saturated fat to less than 10% of energy intake; consumption of at least seven servings (for women) or nine servings (for men) of fruits and vegetables per day; 15 min of strength training exercise every other day and 30 min of endurance exercise each day.
Who delivers the intervention: health counsellor
How often: quarterly newsletters, 15 telephone counselling sessions (15 to 30 min) and 8 prompts: weekly during the first 3 weeks, every other week for 1 month and then monthly.
For how long: 12 months
In what format: mailed print materials (personally tailored workbook and tailored two-page progress report newsletters) and a program of individual telephone counselling and automated telephone prompts. Personalized workbook with bar graphs comparing participants’ current lifestyle behaviours and weight status with recommended levels. Workbook chapters provided standardized content on exercise and a healthy calorie-restricted diet. Participants received a pedometer, exercise bands, an exercise poster depicting six lower extremity strength exercises, a table guide to food portioning and personalized record logs to self-monitor daily exercise and dietary intake.
In what context: home-based | Delayed intervention, wait-list control. | Social cognitive theory [73] Transtheoretical model [74] | -Goal setting (behaviour) -Problem solving -Goal setting (outcome) -Action planning -Review outcome goal(s) -Feedback on behaviour -Self-monitoring of behaviour -Social support (unspecified) -Instruction on how to perform the behaviour -Demonstration of the behaviour -Prompts/cues -Credible source -Social reward -Adding objects to the environment |
Breast cancer survivors
| ||||
Greenlee (2013) [53] USA |
Aims: Diet: reduce caloric intake (1200 cal/day for 1 to 2 weeks, followed by 1600 cal/day) and to distribute calorie intake as 45% protein/30% carbohydrates/25% fat.
Exercise: 3 days/week, 30-min sessions while maintaining 70–75% of maximal heart rate.
Who delivers the intervention: an instructor (diet) and a trainer (exercise), both curves staff (commercial Curves Weight Management Program)
How often: nutrition course consisted of six 1-h weekly group sessions; weekly motivational telephone calls; three to five 30-min personally tailored exercise sessions per week.
For how long: 6 months
In what format: group sessions plus individual telephone counselling. Participants were provided with a Curves weight loss program instruction and recipe book, DVDs and an instructor’s manual. Participant b was also provided with Polar S-610 heart rate monitors (Polar Electro Oy, Finland) to monitor and record heart rate. Dietary sessions started ~1 month after the exercise program.
In what context: Columbia University Medical Center (nutrition course), Curves fitness centre (exercise sessions). | In the wait-list control arm, participants were observed for 6 months during which they were asked not to change their physical activity or diet, followed by 6 months of the Curves program. In the immediate arm, participants received 6 months of the Curves weight loss program, followed by 6 months of observation during which they could engage in any diet and physical activity of their choice. | Not mentioned | -Goal setting (behaviour) -Goal setting (outcome) -Action planning -Biofeedback -Social support (unspecified) -Instruction on how to perform the behaviour -Demonstration of the behaviour -Behavioural practice/rehearsal -Graded tasks -Adding objects to the environment |
Harrigan (2015) [54] USA |
Aim: Diet: reduce energy intake to the range of 1200 to 2000 kcal/day based upon baseline weight and to incur an energy deficit of 500 kcal/day. The dietary fat goal: 25% of total energy intake. Physical activity: 150 min per week of moderate-intensity activity; 10,000 steps per day.
Who delivers the intervention: a registered dietician (Certified Specialist in Oncology Nutrition and trained in exercise physiology and behaviour modification counselling)
How often: 11 30-min individualized counselling sessions once per week in month 1, every 2 weeks in months 2 and 3, and once per month in months 4, 5 and 6.
For how long: 6 months
In what format: Both the in-person and telephone groups received the same lifestyle intervention. Women were provided with a scale, a pedometer, a LEAN Journal, and an | The usual care group was provided with American Institute for Cancer Research nutrition and physical activity brochures and was also referred to the Yale Cancer Center Survivorship Clinic, which offers a two session weight management | Social cognitive theory [73] The weight loss intervention was adapted from the Diabetes Prevention Program, updated with 2010 US Dietary Guidelines, and adapted to the breast cancer survivor population using the American | -Goal setting (behaviour) -Action planning -Self-monitoring of behaviour -Self-monitoring of outcome(s) of behaviour -Social support (unspecified) -Instruction on how to perform the behaviour -Credible source -Adding objects to the environment
Usual care group: – |
Harrigan (2015) USA [54] Continued | 11-chapter LEAN book to guide each session. In-person group: individual face-to-face counselling sessions; Telephone group: individual telephone counselling sessions.
In what context: In-person group: home-based physical activity program; location dietary counselling not mentioned; Telephone group: home-based. | program. At the completion of the study, usual care participants were offered the LEAN book and LEAN Journal, as well as an in-person counselling session. | Institute for Cancer Research/World Cancer Research Fund and American Cancer Society nutrition and physical activity guidelines. | |
Mefferd (2007) USA [58] and Pakiz (2011) USA [59] |
Aims: Primary goal: facilitate a modest weight loss that is sustained, with an emphasis on features that increase this likelihood, such as acceptance of modest weight loss and focusing on skills for weight maintenance. Physical activity: muscle strengthening exercises 2–3 times per week and regular planned aerobic exercise, with an initial goal of daily activity and a step-wise increase in time and intensity with the overall long-term goal of ~1 h per day of moderate to vigorous physical activity. Diet: 500–1000 kcal/day deficit via reduced energy density of the diet plus avoidance of overly strict dieting behaviour that did not promote satiety or long-term maintenance. Participants were encouraged to include high-fibre vegetables, whole grains, fruit and adequate protein to meet nutritional needs and to contribute to satiety.
Who delivers the intervention: Trained investigators and research staff
How often: Closed group sessions: weekly for 4 months, and monthly follow-up sessions through 12 months. Individualized telephone-based counselling: weekly calls in the first month and every other week for the next 2 months and once a month thereafter. It should be noted that both studies only report data collected at baseline and at 16 weeks.
For how long: 16 weeks
In what format: Closed group sessions (with an average of 12–15 women per group) + individualized telephone-based counselling. A pedometer was provided.
In what context: not mentioned | (Wait-list) control group was provided only general contact (monthly check-up calls, holiday and seasonal cards and mailed communications) without specific reference to weight management topics through a 12-month period of data collection. Following that period, they were provided all written intervention materials and a concise version of the didactic material, and facilitated discussion was offered in the format of a 2-day seminar. | Intervention curriculum was based on the new elements of cognitive behavioural therapy [75] for obesity in addition to many elements of standard behavioural treatment for obesity. | -Goal setting (behaviour) -Problem solving -Goal setting (outcome) -Action planning -Review behaviour goal(s) -Feedback on behaviour -Self-monitoring of behaviour -Social support (unspecified) -Instruction on how to perform the behaviour -Information about health consequences -Monitoring of emotional consequences -Demonstration of the behaviour -Behavioural practice/rehearsal -Graded tasks -Reduce negative emotions -Adding objects to the environment -Framing/reframing -Self-talk |
Rock (2015) [61] USA |
Aims: weight loss of at least 7% body weight (at 2 years). Diet: a deficit in energy intake of 500–1000 kcal/day relative to expenditure to promote a weight loss of 1–2 lb/week. Physical activity: The long-term goal was an average of at least 60 min/day of purposeful exercise at a moderate level of intensity.
Who delivers the intervention: counsellors with backgrounds in dietetics, psychology and/or exercise physiology.
How often: 4 months of weekly 1 h group sessions for closed-groups of an average of 15 women, tapering to every other week for 2 months. From 6 months onward, the groups met monthly for the remainder of the year; brief (10- to 15-min) personalized guidance delivered by telephone and/or e-mail: a total of approximately 14–16 counselling calls or contacts in the first study year and a total of 24–38 calls or messages during the two-year period of the intervention. Quarterly tailored print newsletters from 6 to 24 months.
For how long: 24 months
In what format: face-to-face closed-groups counselling sessions with individual telephone counselling, e-mail contact and individually tailored print newsletters. Materials and other items were provided: a participant notebook with worksheets, handouts and illustrations, food and exercise journals, a pedometer, books with caloric content of food, recommended web-based resources for monitoring intake and expenditure, a digital scale and two digital video discs for walking three and five miles.
In what context: partly home-based; location of group sessions not mentioned. | Participants in the less intensive intervention control group were provided weight management resources and materials in the public domain. An individualized diet counselling session was provided at baseline and 6 months, and current physical activity recommendations (at least 30 min per day) were advised. They received monthly telephone calls and/or e-mails from the study coordinator and were invited to attend optional informational seminars on aspects of healthy living other than weight control every other month during the first year. | -Goal setting (behaviour) -Problem solving -Goal setting (outcome) -Action planning -Review behaviour goal(s) -Feedback on behaviour -Self-monitoring of behaviour -Self-monitoring of outcome(s) of behaviour -Social support (unspecified) -Instruction on how to perform the behaviour -Demonstration of the behaviour -Behavioural practice/rehearsal -Graded tasks -Credible source -Non-specific reward -Avoidance/reducing exposure to cues for the behaviour -Adding objects to the environment -Framing/reframing
Control group:
-Goal setting (behaviour) -Action planning -Social support (unspecified) | |
Swisher (2015) [66] USA |
Aims: Physical activity: 150 min per week of moderate-intensity aerobic exercise, defined as rating of perceived exertion of 11–14 (corresponding to 60–75% of peak heart rate achieved on the exercise test). Diet: decrease dietary fat caloric intake by 200 kcal per week.
Who delivers the intervention: exercise physiologists trained in medical rehabilitation (for the supervised exercise sessions) and a dietician, a specialist in nutrition for cancer patients.
How often: individually supervised, moderate-intensity 30-min aerobic exercise sessions three times per week and two unsupervised sessions per week at home; two individual dietary counselling sessions (at the start and approximately 1 month after initial counselling sessions).
For how long: 12 weeks
In what format: individually supervised aerobic exercise sessions and individual face-to-face dietary counselling. Exercise and food logs were provided.
In what context: at an exercise facility (supervised exercise sessions); at home (unsupervised exercise sessions); location of dietary counselling not mentioned. | The control group received written materials about healthy eating for cancer survivors and suggestions on ways to achieve regular physical activity. They were not instructed to avoid diet change or exercise. However, they did not receive any specific counselling or supervision. | Not mentioned | -Goal setting (behaviour) -Action planning -Review behaviour goals -Discrepancy between current behaviour and goal -Monitoring of behaviour by others without feedback -Self-monitoring of behaviour -Social support (unspecified) -Instruction on how to perform the behaviour -Demonstration of the behaviour -Behavioural practice/rehearsal -Credible source
Control:
-Instruction on how to perform the behaviour |
Endometrial cancer survivors
| ||||
Von Gruenigen (2008) [71] USA |
Aims: 5% weight loss in 6 months.
Who delivers the intervention: Registered dietician and the primary investigator
How often: Weekly group contacts for 6 weeks, bi-weekly for 1 month and monthly for 3 months. Participants were contacted by phone or newsletter every week that the group did not meet. Individual face-to face contacts at 3, 6 and 12 months.
For how long: 6 months
In what format: Group + individual sessions face-to-face + contacted by phone or newsletter every week that the group did not meet. Pedometers were provided for patient feedback. Participants saw the primary investigator at 3, 6 and 12 months and received counselling regarding overall health concerns and reinforcement of specific group session topics.
In what context: not mentioned | The usual care group received an informational brochure. To reduce attrition, they were offered a modest monetary incentive ($20.00) for each completed data collection point. The primary investigator saw the usual care group at 3, 6 and 12 months and provided counselling regarding overall health concerns. They did not receive any advice related to weight loss, physical activity or nutrition. | Social cognitive theory [73] | -Goal setting (behaviour) -Problem solving -Goal setting (outcome) -Action planning -Discrepancy between current behaviour and goal -Feedback on behaviour -Self-monitoring of behaviour -Social support (unspecified) -Instruction on how to perform the behaviour -Graded tasks -Non-specific reward -Reduce negative emotions -Adding objects to the environment
Control group:
-Instruction on how to perform the behaviour |
Von Gruenigen (2012) [72] USA |
Aims: 5% weight loss in 6 months. Physical activity: 150 min/week (five times/week for 30 min) for months 1 to 2, 225 min/week (five times/week for 45 min) for months 3 to 4 and 300 min/week (five times/week for 60 min) for months 5 to 6 and 10.000 steps per day or an increase of 2000 steps per day from baseline. Diet: improving diet quality by increasing fruits, vegetables, lean protein, whole grains and low-fat dairy intake and reducing saturated fat, simple carbohydrates and low nutrient/high calorie foods.
Who delivers the intervention: A physician, a psychologist, a registered dietician and a physical therapist
How often: 16 1-h group sessions (10 weekly followed by 6 bi-weekly). Three additional physician face-to-face counselling visits at 3, 6 and 12 months. Continued contact with dietician from 6 to 12 months via telephone, e-mail and newsletters.
For how long: 6 months
In what format: Group (8–10 women per group) and individual counselling; both face-to-face and via telephone, e-mail and newsletters. Participants were given pedometers, a physical activity guide, food/activity records and three-pound hand and adjustable ankle weights.
In what context: not mentioned | The usual care group received an informational brochure (“Healthy Eating and Physical Activity Across Your Lifespan, Better Health and You”). Physician visits for the usual care group consisted of discussion of overall health concerns and review of medications and co-morbidities. | Social cognitive theory [73] | -Goal setting (behaviour) -Goal setting (outcome) -Action planning - Monitoring of outcome(s) of behaviour without feedback -Feedback on behaviour -Self-monitoring of behaviour -Biofeedback -Social support (unspecified) -Instruction on how to perform the behaviour -Credible source -Non-specific reward -Adding objects to the environment
Control group:
-Instruction on how to perform the behaviour |
Behaviour change technique coding
Behaviour change techniquesa (N = 30) | |
---|---|
Goal setting (behaviour) | 8 |
Action planning | 8 |
Social support (unspecified) | 8 |
Instruction on how to perform the behaviour | 8 |
Self-monitoring of behaviour | 7 |
Adding objects to the environment | 7 |
Goal setting (outcome) | 6 |
Demonstration of the behaviour | 5 |
Feedback on behaviour | 5 |
Credible source | 5 |
Behavioural practice/rehearsal | 4 |
Graded tasks | 4 |
Problem solving | 4 |
Review behaviour goal(s) | 3 |
Non-specific reward | 3 |
Biofeedback | 2 |
Self-monitoring of outcome(s) of behaviour | 2 |
Reduce negative emotions | 2 |
Discrepancy between current behaviour and goal | 2 |
Review outcome goal(s) | 1 |
Prompts/cues | 1 |
Social reward | 1 |
Information about health consequences | 1 |
Monitoring of emotional consequences | 1 |
Avoidance/reducing exposure to the behaviour | 1 |
Framing/reframing | 1 |
Self-talk | 1 |
Framing/reframing | 1 |
Monitoring of behaviour by others without feedback | 1 |
Monitoring of outcome(s) of behaviour without feedback | 1 |