title: Lifestyle Behaviors, Perceived Stress, and Inflammation of Individuals With Chronic Graft-Versus-Host Disease.
abstract: BACKGROUND
  Stress is a potent immunomodulator contributing to chronic conditions. Chronic graft-versus-host disease (cGVHD) is a life-threatening late effect of allogeneic hematopoietic cell transplantation associated with stress and exaggerated immune response that may be associated to lifestyle behaviors.
  
  
  OBJECTIVE
  The aim of this study is to explore associations among lifestyle behaviors, perceived stress, and inflammation of individuals with cGVHD.
  
  
  METHODS
  A secondary analysis from a prospective observational study of 24 adults (≥18 years) with cGVHD was conducted. Demographic, clinical, and symptom data were assessed using medical records and validated self-report measures; inflammatory markers were assessed using multiplex and enzyme-linked-immunosorbent assays from plasma.
  
  
  RESULTS
  Spiritual growth and total perceived stress were correlated (P < .001). Nutrition and C-reactive protein were negatively correlated (P = .02). Physical activity and cytokines (interleukin [IL]-2, IL-4, IL-5, IL-7, IL-10, IL-12, IL-13, IL-17, and granulocyte colony-stimulating factor) were associated (P < .05). Perceived stress and inflammatory markers were not associated. Individuals did not routinely engage in assessed health-promoting lifestyle behaviors.
  
  
  CONCLUSIONS
  Associations in this sample were noted among lifestyle behaviors, perceived stress, and inflammation. Given these promising findings, further research with a larger sample size is needed to test these associations. Activity, nutrition, stress management, and social support interventions may reduce stress and inflammation. Particularly, connecting with one's higher-self may reduce levels of perceived stress. Finding ways to engage survivors in healthy lifestyle behaviors should be explored.
  
  
  CONCLUSIONS
  Information from this study allows nurses to be informed about the role of lifestyle behaviors on inflammation and stress to provide anticipatory guidance to HCT survivors regarding lifestyle choices that may mitigate inflammation and stress to promote positive health outcomes.
authors.affiliation: Author Affiliations: College of Nursing (Drs Lynch Kelly, Lyon, and Garvan); College of Psychology (Dr Periera); and College of Medicine (Dr Wingard), University of Florida, Gainesville.
authors.forename: Debra
authors.initials: D
authors.lastname: Lynch Kelly
authors.forename: Debra E
authors.initials: DE
authors.lastname: Lyon
authors.forename: Deidre
authors.initials: D
authors.lastname: Periera
authors.forename: Cynthia
authors.initials: C
authors.lastname: Garvan
authors.forename: John
authors.initials: J
authors.lastname: Wingard
mesh_terms: D000328:Adult; D002908:Chronic Disease; D005260:Female; D006086:Graft vs Host Disease / Q000453:epidemiology*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007249:Inflammation / Q000453:epidemiology*; D008019:Life Style; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013315:Stress, Psychological / Q000523:psychology*; D017741:Survivors / Q000523:psychology / Q000706:statistics & numerical data