Kudos to Isaac Lipkus, professor, and his entire team for the submission of their NIH R01 application entitled: "Exploring the Implementation and Initial Effects of a Stepped-care Approach to Promote Physical Activity among Physically Inactive Breast, Colorectal and Prostate Cancer Survivors." This proposal requests funding for a three-year period with a start date of 9/1/2021.

Breast, prostate and colon cancer survivors who postdiagnosis are more physically active are at lower risk of cancer-specific and all-cause mortality. Interventions promoting physical activity (PA) in these survivors often produce small to moderate increases in moderate to vigorous intensity physical activity (MVPA). Many interventions are highly resource intensive (e.g., multiple in-person/group sessions, supervision, extensive tailoring/telephone counseling) making them less disseminable and can burden survivors who respond well to less intensive intervention. Indeed, to increase moderate intensity PA, some survivors need minimal intervention whereas others need more intensive intervention.

The above strategy is consistent with “stepped care” (SC) whereby Step 1 delivers a minimal intervention to affect MVPA while further steps direct resources toward those who did not respond to mininal intervention. A SC approach has not been tested to increase MVPA among diverse inactive cancer survivors. Thus, data are needed to show initial efficacy of this strategy and key implementation factors that speak to delivery and targeting of intervention. To this end, we will recruit a total of 180 early-stage breast, prostate and colon cancer survivors who are at least a year post-diagnosis and who engage in 0 to 75 minutes of MVPA/week. In Step 1, participants will be randomized in a 1 to 2 ratio to either: 1) attention control; or 2) SC (brochure to motivate PA and goal setting). The SC group will be asked to set their own progressive MVPA goals at 1- to 3-months post-baseline. At 4-months post-baseline, participants in the SC arm who achieved their average MVPA goal based on the prior three months will receive no further intervention and be observed; those who did not meet their average goal at 4-months post-baseline will proceed to Step 2 whereby they will be randomized equally to one of two arms:1) observational control, or 2) health coaching consisting of four bimonthly sessions focused on motivation and self-regulation processes (e.g., planning, addressing barriers). Participants in the attention control arm will receive a brochure on sun safety with no further intervention; they will complete online surveys. For everyone, online surveys will occur at baseline and at 1-4, 6- and 9-months post-baseline. Pattern of effect sizes, adherence and use of study materials, and reactions to health coaching will inform a future SC trial.

This trial attempts to maximize efficacy of resources to promote MVPA in survivors while addressing the needs of those who require it most. Guided by theories that target the formation versus the translation of intentions into actions, the proposed study is the first to explore the promise of using SC to increase MVPA in diverse inactive cancer survivors.

Thank you to all those who gave their time and expertise in guiding the application process as well as to all those who helped to prepare for this submission.