title: Group trajectory analysis helps to identify older cancer survivors who benefit from distance-based lifestyle interventions.
abstract: BACKGROUND
  The number of older cancer survivors is increasing as more adults survive to older ages. The objectives of this study were to examine trajectories of physical activity (PA) and physical function (PF) over a 2-year lifestyle counseling study and to identify characteristics of the trajectory groups.
  
  
  METHODS
  This was a secondary analysis of Reach Out to Enhance Wellness, a randomized controlled trial of home-based lifestyle counseling. The 641 participants were older (≥65 years), overweight (body mass index [BMI], 25 to <40 kg/m(2)), long-term community-dwelling survivors (>5 years) of breast, prostate, and colorectal cancer from Canada, the United Kingdom, and the United States (21 states) who had been randomly assigned to an immediate intervention or a 12-month-wait-listed control arm. The main outcome measures were PA and PF trajectory group membership.
  
  
  RESULTS
  Three PA groups and 5 PF trajectory groups were observed. The baseline BMI (P < .001) and self-efficacy for performing strength (P < .0001) and endurance exercises (P < .0002) were the strongest predictors of achieving the highest amount of PA and the most favorable functional trajectory over 2 years. Individuals with low baseline self-efficacy, no PA, and a Short Form 36 PF subscale score < 65 did not benefit from the intervention.
  
  
  CONCLUSIONS
  This study identified characteristics of survivors who benefited from home-based interventions and suggested alternative approaches for survivors requiring more structured and intensive interventions to promote behavioral changes.
authors.affiliation: Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, North Carolina.|Department of Medicine, Duke University Medical Center, Durham, North Carolina.|Geriatric Research, Education, and Clinical Center, VA Medical Center, Durham, North Carolina.
authors.forename: Miriam C
authors.initials: MC
authors.lastname: Morey
authors.affiliation: Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico.|University of New Mexico Cancer Center, Albuquerque, New Mexico.
authors.forename: Cindy K
authors.initials: CK
authors.lastname: Blair
authors.affiliation: Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, North Carolina.
authors.forename: Richard
authors.initials: R
authors.lastname: Sloane
authors.affiliation: Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, North Carolina.|Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: Harvey Jay
authors.initials: HJ
authors.lastname: Cohen
authors.affiliation: School of Medicine, Duke University, Durham, North Carolina.
authors.forename: Denise C
authors.initials: DC
authors.lastname: Snyder
authors.affiliation: Department of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama.|Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, Alabama.|Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Wendy
authors.initials: W
authors.lastname: Demark-Wahnefried
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D015992:Body Mass Index; D001943:Breast Neoplasms; D002170:Canada; D015179:Colorectal Neoplasms; D003376:Counseling / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D009043:Motor Activity; D009369:Neoplasms; D050177:Overweight / Q000628:therapy*; D011471:Prostatic Neoplasms; D040242:Risk Reduction Behavior; D020377:Self Efficacy; D017741:Survivors; D013689:Telephone; D006113:United Kingdom; D014481:United States; D014850:Waiting Lists
keywords: aged; breast neoplasms; colorectal neoplasms; counseling; exercise; health behavior; lifestyle; prevention and control; prostatic neoplasms; survivors