A healthier life: Cook & Move for Your Life program!

From the Greenlee Group, Public Health Sciences Division

There is little debate that a healthy lifestyle can improve cancer patient outcomes, quality of life, and survival rates. Both the American Institute for Cancer Research (AICR) and the American Cancer Society (ACS) recommend healthy eating habits and regular exercise to reduce the risk of recurrences and deaths associated with cancer. However, despite the many benefits associated with a healthy diet and physical activity, adherence to these recommendations is low among cancer survivors. In a recent study conducted by Dr. Heather Greenlee's group in the Public Health Sciences Division, researchers evaluated the feasibility and effectiveness of promoting healthy eating choices and physical activity among early-stage breast cancer survivors through the online Cook & Move for Your Life (CMFYL) program. The study design was recently published in Contemporary Clinical Trials.

Dr. Greenlee's work aims to develop programs to assist breast cancer survivors with maintaining a healthy diet and an active lifestyle. Her team has developed a bilingual (English/Spanish) Fred Hutch Cook for Your Life website as a means of promoting healthy eating habits among cancer survivors. Cook For Your Life is an online resource that provides evidence-based nutrition information about cancer prevention and recurrence, managing side effects associated with cancer treatment, and improving cancer survivorship. In an earlier study, Dr. Greenlee and her team developed and tested the Mi Vida Saludable (My Healthy Life) program, which aims to promote healthy lifestyles among Latina breast cancer survivors. The authors found that participants of Mi Vida Saludable consumed more fruit and vegetables and exercised more regularly. Perhaps most importantly, these lifestyle changes were maintained throughout the year. Additionally, these programs are open to anyone who wants to make a change and find support and recipes to help them live a healthier life.

Now, Dr. Greenlee's group aims to promote sustainable healthy lifestyles among a wider spectrum of breast cancer survivors through the CMFYL program. Originally, this study was intended to be conducted in-person among breast cancer survivors in Washington State. The pandemic, however, forced the researchers to "change from an in-person cooking and physical activity intervention to a completely online study, including our data collection methods", said Dr. Greenlee. There was a silver lining, however: this digital format allowed them to recruit breast cancer survivors outside of the immediate Seattle area. “This was a big pivot and also a great opportunity to develop new systems so that we can scale this type of intervention going forward,” Dr. Greenlee added.

Cook and Move for your Life is an online nutrition and physical activity educational program to support breast cancer survivors in achieving and sustaining nutrition and physical activity recommendations.
Cook and Move for your Life is an online nutrition and physical activity educational program to support breast cancer survivors in achieving and sustaining nutrition and physical activity recommendations. Image provided by Dr. Greenlee

In this study, each participant received a Fitbit device to self-monitor their physical activity, an actigraph to objectively monitor their physical activity, a kit for collecting blood and stool samples at home, an onlinequestionnaire to collect health behavior characteristics, three telephone calls to assess their diet, and access to the Cook for Your Life website. Participants were divided into low-dose and high-dose groups. The low-dose group received one 90-minute online group session during the first month and served as the control group. The high-dose group received twelve 90-minute online group sessions every two weeks over the course of 6 months. During the online sessions, participants learned about the importance of healthy eating, cooking, shopping, and exercise habits and participated in experiential cooking and exercise actvities. 

Furthermore, participants collected their own blood and stool samples and sent them to Dr. Greenlee's lab for analysis. In addition to evaluating the adhesion, retention, and acceptability of the program, the authors wanted to determine whether markers of inflammation and the gut microbiota changed as a result of the intervention. Since the composition of the human microbiota has been implicated in cancer development, recurrence, and aggressiveness, Dr. Greenlee is interested in investigating whether diet and exercise impact gut microbiota composition. The group is currently hard at work with Dr. Neel Dey analyzing the samples collected for this study. So, stay tuned for their upcoming results! 

This spotlighted research was supported by the Breast Cancer Research Foundation, the Washington State Andy Hill Cancer Research Endowment (CARE) Distinguished Researcher Award and the Fred Hutchinson Cancer Center/University of Washington/ Seattle Children's Cancer Consortium Grant. 

Fred Hutch/University of Washington/Seattle Children's Cancer Consortium member Heather Greenlee contributed to this work.

Ueland K, Sanchez SC, Rillamas-Sun E, Shen H, Schattenkerk L, Garcia G, VanDoren M, Myers SA, Santiago-Torres M, Di C, Dey N, Guthrie KA, Yung R, Davidson NE, Greenlee H. A digital health intervention to improve nutrition and physical activity in breast cancer survivors: Rationale and design of the Cook and Move for Your Life pilot and feasibility randomized controlled trial. Contemp Clin Trials. 2022 Dec;123:106993.