title: Rationale and design of REWARD (revving-up exercise for sustained weight loss by altering neurological reward and drive): a randomized trial in obese endometrial cancer survivors.
abstract: BACKGROUND
  Obesity is a leading risk factor for endometrial cancer (EC), particularly Type I forms, which are increasing in the U.S. Although death rates from most cancers have been decreasing, overall mortality in EC is increasing in the U.S. EC survivors' poor fitness combined with their surgical treatments may make weight loss particularly challenging. High intensity exercise increases neurotrophins and neurological reward via altered striatal dopamine in animals, and, in humans, chronic high intensity exercise enhances meal-induced satiety and may reduce hedonic eating. "Assisted" exercise, a mode of exercise whereby a patient's voluntary exercise rate is augmented mechanically, may modulate brain dopamine levels in Parkinson's Disease patients but has not been previously evaluated as a treatment for obesity.
  
  
  METHODS
  We describe the rationale and design of the REWARD trial, which has the overarching goal of randomizing 120 obese EC survivors to "assisted" or voluntary rate cycling to evaluate the efficacy of "assisted" exercise in enhancing and sustaining weight loss. Patients in both arms will receive 3 days/week of supervised exercise and 1 day/week of a group dietary behavioral intervention for 16 weeks and, then, will be followed for 6 months.
  
  
  RESULTS
  The primary outcome is weight loss. Secondary outcomes include measures for body composition, fitness, eating behavior, exercise motivation and, quality of life as well as cognition and food reward and motivation as assessed by functional magnetic resonance imaging (fMRI) tasks.
  
  
  CONCLUSIONS
  If successful, the REWARD program could be extended to help sustain weight loss in obese cancer and non-cancer patients.
authors.affiliation: Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA; Case Comprehensive Cancer Center, Cleveland, OH, USA. Electronic address: nln@case.edu.
authors.forename: Nora L
authors.initials: NL
authors.lastname: Nock
authors.affiliation: Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Dimitropoulos
authors.affiliation: Schey Center for Cognitive Neuroimaging, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Rao
authors.affiliation: Case Comprehensive Cancer Center, Cleveland, OH, USA; Department of Radiology, Case Western Reserve University, Cleveland, OH, USA; Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Chris A
authors.initials: CA
authors.lastname: Flask
authors.affiliation: Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Schluchter
authors.affiliation: Department of Reproductive Biology, Case Western Reserve University, Cleveland, OH, USA; Gynecologic Oncology, University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Kristine M
authors.initials: KM
authors.lastname: Zanotti
authors.affiliation: Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Rose
authors.affiliation: Department of Pathobiology, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Kirwan
authors.affiliation: Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Jay
authors.initials: J
authors.lastname: Alberts
mesh_terms: D001521:Behavior Therapy / Q000379:methods*; D015415:Biomarkers; D001823:Body Composition; D015992:Body Mass Index; D004032:Diet; D016889:Endometrial Neoplasms / Q000453:epidemiology*; D015444:Exercise; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D009042:Motivation; D009765:Obesity / Q000453:epidemiology* / Q000628:therapy*; D010809:Physical Fitness; D011788:Quality of Life; D012107:Research Design; D012959:Socioeconomic Factors; D017741:Survivors; D015431:Weight Loss
chemical_list: D015415:Biomarkers
keywords: Eating behavior; Endometrial cancer; Exercise; Obesity; Quality of life; fMRI