Behavior change techniques in physical activity and dietary interventions among adolescent and young adult cancer survivors: a systematic review and meta-analysis of randomized controlled trials.
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PURPOSE: This systematic review and meta-analysis aimed to synthesize the evidence from physical activity (PA) and dietary behavior change interventions designed specifically for adolescent and young adult (AYAs) cancer survivors. We identified study characteristics and behavior change techniques (BCTs), examined intervention effectiveness, and explored study characteristics and BCTs associated with effectiveness. METHODS: A comprehensive search of multiple databases was conducted (March 2024) for randomized controlled trials (RCTs) conducted among post-treatment cancer survivors diagnosed during adolescence or young adulthood (15-39 years), comparing PA or dietary outcomes. Two reviewers screened all studies, extracted data, and characterized interventions by BCTs. Analyses weighted effect sizes (Hedges g) by their inverse variance and combine them using multilevel random effects meta-analytic procedures. Random effects univariate regressions examined the association between study characteristics, BCTs, and effectiveness. RESULTS: Fourteen RCTs (n = 1169) were included for review. All studies had multiple outcomes of interest, including PA; two included dietary components. There was a significant overall intervention effect on PA (0.378, 95% CI, 0.183-0.573; p = 0.002). Significant moderators were the type of PA outcome assessed, the use of two behavioral theories, and biofeedback. Other BCTs showed notable differences in effect size, though not significant. DISCUSSION: Interventions improved PA outcomes in AYA cancer survivors. Most studies were pilot or feasibility trials, lasting three months. Future research should prospectively identify BCTs and examine their effects post-intervention. Interventions targeting both PA and dietary behaviors are lacking. IMPLICATIONS FOR CANCER SURVIVORS: There is a need for behavioral interventions designed specifically to meet the unique needs of AYA cancer survivors and future studies should include PA and dietary components, larger and more diverse samples, and longer follow-up periods. REGISTRATION: PROSPERO (reference: CRD42022198889).