# Project 3: Simultaneous Combined Or Sequential (S.O.S.) Approaches to Behavior Change for Survivors

> **NIH NIH P01** · UNIVERSITY OF ALABAMA AT BIRMINGHAM · 2021 · $277,558

## Abstract

Health risks (poor diet, excess weight, physical inactivity) in rising numbers of cancer survivors represent a 
substantial public health concern and can lead to second primaries and cancer recurrence, as well as other 
comorbidities and functional decline. Effective behavioral interventions are needed for this population. Studies 
to date have largely addressed individual lifestyle behaviors as independent factors, but there often are 
multiple health risks that require attention amongst survivors. Thus, intervening upon multiple modifiable risk 
factors is much more likely to impact public health than intervening on a single behavior. Multiple behavior 
change interventions have shown success in the general population, as well as promising results in the few 
available studies in cancer survivors. However, several gaps in this research remain. First, there is no 
consensus on the best approach to multiple behavior change and the few studies that have compared 
simultaneous vs. sequential multiple behavior interventions yielded mixed findings. Clarifying best practices for 
multiple behavior change has important clinical implications and will be key to moving the field forward. 
Second, this line of research has yet to be fully extended to at risk populations. As noted, there have been 
some multiple behavior change studies conducted in cancer survivors, but none have examined simultaneous 
vs. sequential intervention approaches and most involved predominantly younger, well-educated White 
samples. The National Cancer Institute has called for multiple behavior change research in underserved 
populations, i.e., survivors of various cancers who also are rural, older and minority. Thus, the proposed 
Project 3, which builds upon Projects 1-2 of AMPLIFI, will test the efficacy of simultaneous vs. sequential 
interventions targeting diet, weight loss, and/or exercise, and explore which combination or order is best to 
maximize change for cancer survivors. The study will use a randomized controlled design with 652 cancer 
survivors from mostly older, rural, and minority groups. Primary aims include determining the relative efficacy 
of two approaches (simultaneous vs. sequenced) to multiple health behavior change, with meeting behavioral 
goals (improved diet quality, 3% weight loss, ≥150 weekly minutes of ≥moderate intensity physical activity) 
post-intervention as endpoints of interest. Secondary aims include examining maintenance of gains at 6 
months post-intervention and arm differences in physical activity and function, lean body mass, quality of life, 
and biomarkers of successful aging, immune status, and systemic inflammation; identifying potential mediators 
(SCT constructs) and moderators (education) of intervention efficacy; and evaluating the cost-effectiveness of 
sequenced vs. simultaneous technology-based interventions. This will be one of the largest trials ever to 
compare sequential vs. simultaneous interventions. Findings will be o...

## Key facts

- **NIH application ID:** 10247782
- **Project number:** 5P01CA229997-04
- **Recipient organization:** UNIVERSITY OF ALABAMA AT BIRMINGHAM
- **Principal Investigator:** Dorothy W. Pekmezi
- **Activity code:** P01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $277,558
- **Award type:** 5
- **Project period:** 2018-09-01 → 2024-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10247782

## Citation

> US National Institutes of Health, RePORTER application 10247782, Project 3: Simultaneous Combined Or Sequential (S.O.S.) Approaches to Behavior Change for Survivors (5P01CA229997-04). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10247782. Licensed CC0.

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