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JMIR Cancer. 2017 Sep 21;3(2):e13. doi: 10.2196/cancer.7495.

A Lifestyle Intervention via Email in Minority Breast Cancer Survivors: Randomized Parallel-Group Feasibility Study.

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Department of Community Medicine and Population Health, The University of Alabama, Tuscaloosa, AL, United States.
Center for Health Equity and Evaluation Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
Texas Health Resources, Texas Health Harris Methodist Hospital, Fort Worth, TX, United States.
School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, United States.
Institute of Healthy Aging, University of North Texas Health Science Center, Forth Worth, TX, United States.
Department of Health Promotion and Behavior Sciences, The University of Texas Health Science Center at Houston, Houston, TX, United States.
Department of Mexican American & Latina/o Studies, The University of Texas at Austin, Austin, TX, United States.
Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB, Canada.
Turnaround Health, a division of NutritionQuest, Berkeley, CA, United States.
School of Public Health, University of California at Berkeley, Berkeley, CA, United States.
School of Public Health, Texas A&M Health Science Center, Bryan, TX, United States.



Our data have indicated that minority breast cancer survivors are receptive to participating in lifestyle interventions delivered via email or the Web, yet few Web-based studies exist in this population.


The aim of this study was to examine the feasibility and preliminary results of an email-delivered diet and activity intervention program, "A Lifestyle Intervention Via Email (ALIVE)," delivered to a sample of racial and ethnic minority breast cancer survivors.


Survivors (mean age: 52 years, 83% [59/71] African American) were recruited and randomized to receive either the ALIVE program's 3-month physical activity track or its 3-month dietary track. The fully automated system provided tools for self-monitoring and goal setting, tailored content, and automated phone calls. Descriptive statistics and mixed-effects models were computed to examine the outcomes of the study.


Upon completion, 44 of 71 survivors completed the study. Our "intention-to-treat" analysis revealed that participants in the physical activity track made greater improvements in moderate to vigorous activity than those in the dietary track (+97 vs. +49 min/week, P<.001). Similarly, reductions in total sedentary time among those in the physical activity track (-304 vs. -59 min/week, P<.001) was nearly 5 times greater than that for participants in the dietary track. Our completers case analysis indicated that participants in the dietary track made improvements in the intake of fiber (+4.4 g/day), fruits and vegetables (+1.0 cup equivalents/day), and reductions in saturated fat (-2.3 g/day) and trans fat (-0.3 g/day) (all P<.05). However, these improvements in dietary intake were not significantly different from the changes observed by participants in the physical activity track (all P>.05). Process evaluation data indicated that most survivors would recommend ALIVE to other cancer survivors (97%), were satisfied with ALIVE (82%), and felt that ALIVE was effective (73%). However, survivors expressed concerns about the functionality of the interactive emails.


ALIVE appears to be feasible for racial and ethnic minority cancer survivors and showed promising results for larger implementation. Although survivors favored the educational content, a mobile phone app and interactive emails that work on multiple email domains may help to boost adherence rates and to improve satisfaction with the Web-based platform.

TRIAL REGISTRATION: NCT02722850; (Archived by WebCite at


African Americans; Internet; breast neoplasm; computer tailoring; diet; email; feasibility study; physical activity; posture; program evaluation

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