ImpRoving hEalth behaviourS for LIfe After ENdometrial CancEr Trial (RESILIENCE)

The RESILIENCE Trial: Using a Multimodal and Digital Intervention to Optimize Waist Circumference, Body Composition, and Cardiometabolic Health in Endometrial Cancer Survivors.

RESILIENCE is 24-week randomized controlled trial that assesses the efficacy of a web-based health platform, combined with online support from healthcare professionals, to enhance waist circumference and other vital health outcomes in endometrial cancer survivors.

Background: Individuals diagnosed with endometrial cancer are at an increased risk of cardiac complications post-treatment, particularly if having overweight or a pronounced waist size. Adopting healthy habits-like nutritious eating, regular physical activity, and effective stress management-can mitigate these risks and bolster overall health. However, many cancer survivors find it challenging to consistently adhere to these health and wellness recommendations. Objective: This study aims to determine the efficacy of a web-based health platform, enriched with professional guidance, in facilitating healthier lifestyles for endometrial cancer survivors. This would encompass enhancements in nutrition, physical activity levels, and mindfulness practices. Study Design: Group 1 (Intervention Group): Participants will engage with the web-based health platform daily for the initial 16 weeks with expert guidance. Subsequently, participants will navigate the platform independently for the next 8 weeks. Group 2 (Control Group): Participants will initially be provided with standard publicly accessible health information. After the primary 24-week period, participants will gain access to the web-based wellness platform. Common Elements: Both groups will have access to general health information and will benefit from supportive calls. To monitor their physical activity, all participants will be equipped with an activity tracker.

Participants will receive the intervention for 24 weeks. The first 16 weeks will involve an intensive behavioral program (web-based health platform plus online healthcare professional support), followed by an 8-week maintenance period (web-based platform alone). At baseline, participants will receive handouts with publicly available health information; they will also wear an activity monitor and receive support telephone calls for the 24 weeks.

At baseline, participants will receive handouts with publicly available health information; they will also wear an activity monitor and receive support telephone calls for the 24 weeks.

A web-based platform based on preventive self-care that contains tools to monitor nutrition, physical activity, and mental wellbeing will be accessed daily for 24 weeks.

Individual and group sessions with a Registered Dietitian, Qualified Exercise professional, and Mental Health Professional for 16 weeks.

Waist circumference will be measured in centimeters (cm) using an inelastic tape at the level of the iliac crest at the end of normal expiration.

Waist circumference will be measured in centimeters (cm) using an inelastic tape at the level of the iliac crest at the end of normal expiration.

Weight will be measured in kilograms (kg) in triplicate following standardized procedures; average values will be used for analysis.

Percentage fat mass will be measured using dual-energy x-ray absorptiometry (DXA), which is a precise and reliable technique.

Appendicular lean soft tissue will be measured using dual-energy x-ray absorptiometry (DXA), which is a precise and reliable technique. Appendicular lean soft tissue will be adjusted for body weight.

Metabolic syndrome severity Z score will be calculated using waist circumference, blood pressure, high-density lipoprotein cholesterol, triglycerides, and fasting glucose data in sex- and ethnicity-specific equations.

10-year cardiovascular risk will be estimated using sex-specific Framingham risk score based on traditional risk factors. Risk is low if the score is less than 10% and high if it is 20% or higher.

Change from baseline in cardiorespiratory fitness by a cardiopulmonary exercise testing (CPET) at weeks 16 and 24.

Participants will complete the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core-30 (QLQ-C30). Score ranges from 0 to 100. Higher scores on symptoms and single-items indicate a higher level of symptoms.

Participants will complete the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire -Endometrial Cancer Module (EORTC QLQ-EN24). Score ranges from 0 to 100. Higher scores on symptoms and single-items indicate a higher level of symptoms.

Inclusion Criteria: ≥ 18 years old History of endometrial cancer (low-grade, early stage). 1 month to 5 years post-surgery and completion of adjuvant treatment. BMI ≥30 and ≤45 kg/m2. Able to speak, read and understand English. Exclusion Criteria: Recurrent or metastatic disease. Weight fluctuations (±5 kg) within the previous 3 months. Type 1 diabetes; uncontrolled thyroid disorder or type 2 diabetes. Taking medications that may alter energy metabolism, body weight and composition. Self-report >90 moderate-intensity min/week of aerobic physical activity on average over the past three months. Potential safety risk with exercise or maximal exercise testing, or physical or mobility limitations impacting ability to perform physical activity. Self-report following a structured hypocaloric or a restrictive diet in the past three months, or self-report currently following a vegan diet but for no more than two years. Self-reported history of an eating disorder diagnosed by a physician. Contraindications for imaging tests, such as pacemakers, pregnancy, and magnetic implants.