African Americans, Breast Neoplasm Female, Cancer Survivors, Cardiometabolic Syndrome, Exercise, Feasibility Studies, Psychology, Positive, Women
Conditions
Keywords
African American Women, Breast Cancer Survivorship, Gratitude, Cardiometabolic Syndrome, Geriatrics, Physical Activity
Brief summary
This pilot study will assess the feasibility of a gratitude intervention to promote physical activity, and well-being and positively impact biomarkers of health among older African American breast cancer survivors. The intervention will also include a goal-setting component to promote exercise readiness and examine the cultural phenomena of the Superwoman schema among Black women.
Detailed description
In this pilot feasibility study, the overall aims are: Aim 1. Assess the feasibility and acceptability of a gratitude journaling intervention using a pilot randomized controlled trial (RCT) design over eight weeks. We hypothesize that among the 28 participants 1) at least 80% of the participants will report the intervention to be acceptable, 2) biomarker collection will be completed in at least 80% of the surveys and the retention rate will be 80% in each group, and 3) physical activity, health markers, gratitude, well-being, and distress will improve over time. Aim 2. Describe distributions of outcome variables and effect size for the gratitude journaling intervention on dispositional gratitude, spiritual well-being, psychological distress, exercise readiness, mental and health behaviors in African American/Black women (Superwoman Schema), and inflammatory biomarkers from baseline to post-intervention.
Interventions
BEHAVIORALGratitude Intervention
Gratitude journaling and goal setting for exercise readiness over eight weeks.
Sponsors
National Institute on Aging (NIA)
University of Florida
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Outcomes Assessor)
Masking description
The principal investigator will inform participants of their group assignment and provide intervention details. The research assistant and biostatistician will be blind to group allocation.
Intervention model description
Two-group parallel random-assignment experimental design.
Eligibility
Sex/Gender
FEMALE
Age
50 Years to 99 Years
Healthy volunteers
Yes
Inclusion criteria
* Self-report as AA or Black * English speaking * History of BC (Stage I-IV); 3 months to 6 years post-adjuvant chemotherapy * Participants on hormonal therapies or HER-2 therapy are acceptable
Exclusion criteria
* Self-reported regular meditation or gratitude practices (more than once a week for at least a month) * Meeting the CDC's physical activity guidelines (at least 150 min of moderate-intensity aerobic physical activity or 75 min of vigorous-intensity physical activity, or an equivalent combination each week)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Participants Who Met Inclusion Criteria Compared to Participants Approached | 8 months | Percentage of women who meet the inclusion criteria relative to the number of women approached. |
| Participant Completion of Baseline Assessment Measures | Week 0 | Percentage of participants completing baseline assessment measures. |
| Participant Completion of Both Baseline Assessments and Post-intervention Assessments | Week 0, Week 8 | Percentage of participants who completed baseline assessments and completed the post-intervention assessments. |
| Treatment Satisfaction Using Client Satisfaction Questionnaire (CSQ-8) | Week 8 | We assessed treatment satisfaction using the mean Client Satisfaction Questionnaire(CSQ-8) scores. An overall score is calculated by summing the respondent's rating score for each scale item. Scores range from 8 to 32, with higher values indicating higher satisfaction. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Exercise Readiness From Baseline to Post-intervention | Week 0, Week 8 | The Exercise Readiness Scale measured the stages of exercise behavior change at baseline and post-intervention. The scale consists of five items assessing exercise behavior and intentions. Participants choose one statement that best describes their current level of physical activity, with options ranging from 1 (no participation in physical activity and no intention to start) to 5 (exercising regularly for more than 6 months). Scores range from 1 to 5, with higher scores indicating greater readiness for regular physical activity and higher stages of exercise behavior change. |
| Change in Dispositional Gratitude From Baseline to Post-intervention | Week 0, Week 8 | The mean change of dispositional gratitude measured at week 0/baseline and post-intervention/week 8 was measured using the Gratitude Questionnaire-6 designed to measure four facets of dispositional gratitude: (a) intensity, (b) frequency, (c) span, and (d) density. The scale consists of six items, each rated on a 7-point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). To calculate the GQ-6 score, each item's score is summed to yield a total score. The minimum possible score is 6, indicating the lowest level of gratitude, and the maximum possible score is 42, indicating the highest level of gratitude. For example, if a participant's responses to the six items are 5 (slightly agree), 6 (agree), 4 (neutral), 7 (strongly agree), 3 (slightly disagree), and 5 (slightly agree), the total score would be 30. This total score is then used to gauge the participant's level of gratitude, with higher scores reflecting greater gratitude. |
| Change in C-Reactive Protein From Baseline to Post-intervention | Week 0, Week 8 | The mean change of inflammatory biomarkers baseline/week 0 and post-intervention/week 8 was measured using a Enzyme-linked immunosorbent assay (ELISA) kit containing C-Reactive Protein. |
| Change in Tumor Necrosis Factor Alpha (TNF-α), Interleukin 6 (IL-6), Growth/Differentiation Factor-15 (GDF15) From Baseline to Post-intervention | Week 0, Week 8 | The mean change of inflammatory biomarkers baseline/week 0 and post-intervention/week 8 was measured using a Luminex panel containing Tumor Necrosis Factor Alpha (TNF-α), Interleukin 6 (IL-6), Growth/Differentiation Factor-15 (GDF15). |
| Change in Spiritual Well-being From Baseline to Post-intervention | Week 0, Week 8 | The Functional Assessment of Chronic Illness Therapy - Spiritual Well-Being is a self-report measure designed to assess spiritual well-being in individuals with chronic illness. It was used to report mean change from week 0/baseline and post-intervention/week 8. The scale comprises 12 items divided into two subscales: Meaning/Peace and Faith. Each item is rated on a 5-point Likert scale ranging from 0 (not at all) to 4 (very much). To calculate the FACIT-Sp-12 score, each item's score is summed. The Meaning/Peace subscale score is obtained by summing the scores of items 1 to 8, with a range of 0 to 32. The Faith subscale score is derived from items 9 to 12, with a range of 0 to 16. The total spiritual well-being score, which combines both subscales, ranges from 0 to 48. Higher scores on the FACIT-Sp-12 indicate greater spiritual well-being. |
| Change in Distress From Baseline to Post-intervention | Week 0, Week 8 | The mean change of distress baseline/week 0 and post-intervention/week 8 was measured using the Perceived Stress Scale designed to measure stress during the last month. The scale consists of 10 items, each rated on a 5-point Likert scale ranging from 0 (never) to 4 (very often). To calculate the PSS score, each item's score is summed, with items 4, 5, 7, and 8 being reverse-scored to account for their positive phrasing. The reversed scoring for these items means that a response of 0 becomes 4, 1 becomes 3, 2 remains 2, 3 becomes 1, and 4 becomes 0. The total score, ranging from 0 to 40, reflects the individual's perceived stress level, with higher scores indicating greater stress. |
| Change in Superwoman Schema (Racial and Gender Identity) From Baseline to Post-intervention | Week 0, Week 8 | The Giscombe Superwoman Schema Questionnaire (GSSQ) measured the mean change in Superwoman Schema between baseline and post-intervention at weeks 0 and 8. The GSSQ consists of 35 items across five dimensions: obligation to manifest strength (6 items), obligation to suppress emotions (7 items), resistance to being vulnerable (7 items), intense motivation to succeed (6 items), and obligation to help others (9 items). Items are rated on a Likert scale from 0 (not true) to 3 (true all the time). The total score ranges from 0 to 105, with subscale ranges as follows: Strength (0-18), Suppress (0-21), Resistance (0-21), Motivation (0-18), and Help (0-27). Higher scores indicate stronger endorsement of the Superwoman Schema. Total and subscale scores are summed, with higher scores representing stronger schema identification. |
Countries
United States
Participant flow
Recruitment details
Participants were recruited using organic social media recruitment, flyers, and multiple specialized strategies, including the OAIC Pepper Center Clinical Research Core - Participant Registry (IRB201601352), UF Health Cancer Center Community-Partnered Cancer Disparities Research Collaborative, UF Health Cancer Center Community Outreach and Engagement, UF Healthstreet, Integrated Data Repository, and UF Consent2Share Registries. Potential participants were screened for eligibility via telephone.
Participants by arm
| Arm | Count |
|---|---|
| Gratitude Intervention Each participant will receive a gratitude journal (paperback or electronic journal based on preference) for eight weeks and will have the following journaling prompt to complete at least twice a week: There are many things in our lives, both large and small, that we might be grateful about. Think back over the day and write down on the line below all that you are grateful for today (maximum six reasons). The educational goal-setting component will be drawn from the American Cancer Society's Nutrition, Physical Activity, and Cancer toolkit. Participants will be able to choose the order in which they complete the goal-setting modules. Both exercises will be administered daily over eight weeks.
Gratitude Intervention: Gratitude journaling and goal setting for exercise readiness over eight weeks. | 13 |
| Attention Control Each participant will receive a journal (paperback or electronic journal based on preference) Participants will receive the following general journaling prompt to complete at least twice a week: What are some memorable events that happened to you today, big, or small (maximum six memories). Write a brief statement about it. | 13 |
| Total | 26 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Lost to Follow-up | 5 | 2 |
Baseline characteristics
| Characteristic | Total | Attention Control | Gratitude Intervention |
|---|---|---|---|
| Age, Continuous | 65.0 years STANDARD_DEVIATION 7.9 | 66.7 years STANDARD_DEVIATION 9.1 | 63.4 years STANDARD_DEVIATION 6.5 |
| Body Mass Index | 33.9 kg/m2 STANDARD_DEVIATION 8.7 | 31.7 kg/m2 STANDARD_DEVIATION 5.7 | 36.1 kg/m2 STANDARD_DEVIATION 10.7 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 0 Participants | 0 Participants | 0 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 26 Participants | 13 Participants | 13 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Height | 64.5 inches STANDARD_DEVIATION 3.1 | 63.5 inches STANDARD_DEVIATION 2.8 | 65.5 inches STANDARD_DEVIATION 3.2 |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 26 Participants | 13 Participants | 13 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 0 Participants | 0 Participants | 0 Participants |
| Region of Enrollment United States | 26 participants | 13 participants | 13 participants |
| Sex: Female, Male Female | 26 Participants | 13 Participants | 13 Participants |
| Sex: Female, Male Male | 0 Participants | 0 Participants | 0 Participants |
| Weight | 201.8 pounds STANDARD_DEVIATION 59.3 | 181.1 pounds STANDARD_DEVIATION 39.8 | 222.5 pounds STANDARD_DEVIATION 69.3 |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 13 | 0 / 13 |
| other Total, other adverse events | 0 / 13 | 0 / 13 |
| serious Total, serious adverse events | 0 / 13 | 0 / 13 |
Outcome results
Primary
Participant Completion of Baseline Assessment Measures
Percentage of participants completing baseline assessment measures.
Time frame: Week 0
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Gratitude Intervention | Participant Completion of Baseline Assessment Measures | 13 Participants |
| Attention Control | Participant Completion of Baseline Assessment Measures | 13 Participants |
Primary
Participant Completion of Both Baseline Assessments and Post-intervention Assessments
Percentage of participants who completed baseline assessments and completed the post-intervention assessments.
Time frame: Week 0, Week 8
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Gratitude Intervention | Participant Completion of Both Baseline Assessments and Post-intervention Assessments | 8 Participants |
| Attention Control | Participant Completion of Both Baseline Assessments and Post-intervention Assessments | 11 Participants |
Primary
Participants Who Met Inclusion Criteria Compared to Participants Approached
Percentage of women who meet the inclusion criteria relative to the number of women approached.
Time frame: 8 months
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Gratitude Intervention | Participants Who Met Inclusion Criteria Compared to Participants Approached | 13 Participants |
| Attention Control | Participants Who Met Inclusion Criteria Compared to Participants Approached | 13 Participants |
Primary
Treatment Satisfaction Using Client Satisfaction Questionnaire (CSQ-8)
We assessed treatment satisfaction using the mean Client Satisfaction Questionnaire(CSQ-8) scores. An overall score is calculated by summing the respondent's rating score for each scale item. Scores range from 8 to 32, with higher values indicating higher satisfaction.
Time frame: Week 8
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Gratitude Intervention | Treatment Satisfaction Using Client Satisfaction Questionnaire (CSQ-8) | 29.8 score on a scale | Standard Deviation 3.7 |
| Attention Control | Treatment Satisfaction Using Client Satisfaction Questionnaire (CSQ-8) | 29.2 score on a scale | Standard Deviation 3 |
Secondary
Change in C-Reactive Protein From Baseline to Post-intervention
The mean change of inflammatory biomarkers baseline/week 0 and post-intervention/week 8 was measured using a Enzyme-linked immunosorbent assay (ELISA) kit containing C-Reactive Protein.
Time frame: Week 0, Week 8
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Gratitude Intervention | Change in C-Reactive Protein From Baseline to Post-intervention | 3.1 mg/L | Standard Deviation 6 |
| Attention Control | Change in C-Reactive Protein From Baseline to Post-intervention | 0.6 mg/L | Standard Deviation 2.6 |
Secondary
Change in Dispositional Gratitude From Baseline to Post-intervention
The mean change of dispositional gratitude measured at week 0/baseline and post-intervention/week 8 was measured using the Gratitude Questionnaire-6 designed to measure four facets of dispositional gratitude: (a) intensity, (b) frequency, (c) span, and (d) density. The scale consists of six items, each rated on a 7-point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). To calculate the GQ-6 score, each item's score is summed to yield a total score. The minimum possible score is 6, indicating the lowest level of gratitude, and the maximum possible score is 42, indicating the highest level of gratitude. For example, if a participant's responses to the six items are 5 (slightly agree), 6 (agree), 4 (neutral), 7 (strongly agree), 3 (slightly disagree), and 5 (slightly agree), the total score would be 30. This total score is then used to gauge the participant's level of gratitude, with higher scores reflecting greater gratitude.
Time frame: Week 0, Week 8
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Gratitude Intervention | Change in Dispositional Gratitude From Baseline to Post-intervention | 0.5 score on a scale | Standard Deviation 1.3 |
| Attention Control | Change in Dispositional Gratitude From Baseline to Post-intervention | -0.3 score on a scale | Standard Deviation 1 |
Secondary
Change in Distress From Baseline to Post-intervention
The mean change of distress baseline/week 0 and post-intervention/week 8 was measured using the Perceived Stress Scale designed to measure stress during the last month. The scale consists of 10 items, each rated on a 5-point Likert scale ranging from 0 (never) to 4 (very often). To calculate the PSS score, each item's score is summed, with items 4, 5, 7, and 8 being reverse-scored to account for their positive phrasing. The reversed scoring for these items means that a response of 0 becomes 4, 1 becomes 3, 2 remains 2, 3 becomes 1, and 4 becomes 0. The total score, ranging from 0 to 40, reflects the individual's perceived stress level, with higher scores indicating greater stress.
Time frame: Week 0, Week 8
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Gratitude Intervention | Change in Distress From Baseline to Post-intervention | -2.1 score on a scale | Standard Deviation 4.9 |
| Attention Control | Change in Distress From Baseline to Post-intervention | -1.3 score on a scale | Standard Deviation 4.5 |
Secondary
Change in Exercise Readiness From Baseline to Post-intervention
The Exercise Readiness Scale measured the stages of exercise behavior change at baseline and post-intervention. The scale consists of five items assessing exercise behavior and intentions. Participants choose one statement that best describes their current level of physical activity, with options ranging from 1 (no participation in physical activity and no intention to start) to 5 (exercising regularly for more than 6 months). Scores range from 1 to 5, with higher scores indicating greater readiness for regular physical activity and higher stages of exercise behavior change.
Time frame: Week 0, Week 8
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Gratitude Intervention | Change in Exercise Readiness From Baseline to Post-intervention | 0.8 score on a scale | Standard Deviation 1.5 |
| Attention Control | Change in Exercise Readiness From Baseline to Post-intervention | -0.2 score on a scale | Standard Deviation 0.6 |
Secondary
Change in Spiritual Well-being From Baseline to Post-intervention
The Functional Assessment of Chronic Illness Therapy - Spiritual Well-Being is a self-report measure designed to assess spiritual well-being in individuals with chronic illness. It was used to report mean change from week 0/baseline and post-intervention/week 8. The scale comprises 12 items divided into two subscales: Meaning/Peace and Faith. Each item is rated on a 5-point Likert scale ranging from 0 (not at all) to 4 (very much). To calculate the FACIT-Sp-12 score, each item's score is summed. The Meaning/Peace subscale score is obtained by summing the scores of items 1 to 8, with a range of 0 to 32. The Faith subscale score is derived from items 9 to 12, with a range of 0 to 16. The total spiritual well-being score, which combines both subscales, ranges from 0 to 48. Higher scores on the FACIT-Sp-12 indicate greater spiritual well-being.
Time frame: Week 0, Week 8
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Gratitude Intervention | Change in Spiritual Well-being From Baseline to Post-intervention | 3.6 score on a scale | Standard Deviation 8 |
| Attention Control | Change in Spiritual Well-being From Baseline to Post-intervention | -1.8 score on a scale | Standard Deviation 3.1 |
Secondary
Change in Superwoman Schema (Racial and Gender Identity) From Baseline to Post-intervention
The Giscombe Superwoman Schema Questionnaire (GSSQ) measured the mean change in Superwoman Schema between baseline and post-intervention at weeks 0 and 8. The GSSQ consists of 35 items across five dimensions: obligation to manifest strength (6 items), obligation to suppress emotions (7 items), resistance to being vulnerable (7 items), intense motivation to succeed (6 items), and obligation to help others (9 items). Items are rated on a Likert scale from 0 (not true) to 3 (true all the time). The total score ranges from 0 to 105, with subscale ranges as follows: Strength (0-18), Suppress (0-21), Resistance (0-21), Motivation (0-18), and Help (0-27). Higher scores indicate stronger endorsement of the Superwoman Schema. Total and subscale scores are summed, with higher scores representing stronger schema identification.
Time frame: Week 0, Week 8
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Gratitude Intervention | Change in Superwoman Schema (Racial and Gender Identity) From Baseline to Post-intervention | Strength subscale | -0.4 score on a scale | Standard Deviation 1.9 |
| Gratitude Intervention | Change in Superwoman Schema (Racial and Gender Identity) From Baseline to Post-intervention | Suppress emotions subscale | -0.8 score on a scale | Standard Deviation 4.2 |
| Gratitude Intervention | Change in Superwoman Schema (Racial and Gender Identity) From Baseline to Post-intervention | Resistance to vulnerability subscale | -2.1 score on a scale | Standard Deviation 4.2 |
| Gratitude Intervention | Change in Superwoman Schema (Racial and Gender Identity) From Baseline to Post-intervention | Motivation to succeed subscale | -1.3 score on a scale | Standard Deviation 3.2 |
| Gratitude Intervention | Change in Superwoman Schema (Racial and Gender Identity) From Baseline to Post-intervention | Care for others subscale | 0.1 score on a scale | Standard Deviation 5.5 |
| Gratitude Intervention | Change in Superwoman Schema (Racial and Gender Identity) From Baseline to Post-intervention | Total score | -4.4 score on a scale | Standard Deviation 11.4 |
| Attention Control | Change in Superwoman Schema (Racial and Gender Identity) From Baseline to Post-intervention | Care for others subscale | 1.3 score on a scale | Standard Deviation 6.8 |
| Attention Control | Change in Superwoman Schema (Racial and Gender Identity) From Baseline to Post-intervention | Strength subscale | -0.9 score on a scale | Standard Deviation 3.9 |
| Attention Control | Change in Superwoman Schema (Racial and Gender Identity) From Baseline to Post-intervention | Motivation to succeed subscale | -1.0 score on a scale | Standard Deviation 4.4 |
| Attention Control | Change in Superwoman Schema (Racial and Gender Identity) From Baseline to Post-intervention | Suppress emotions subscale | 0.5 score on a scale | Standard Deviation 5.2 |
| Attention Control | Change in Superwoman Schema (Racial and Gender Identity) From Baseline to Post-intervention | Total score | 1.1 score on a scale | Standard Deviation 23.9 |
| Attention Control | Change in Superwoman Schema (Racial and Gender Identity) From Baseline to Post-intervention | Resistance to vulnerability subscale | -0.3 score on a scale | Standard Deviation 7.6 |
Secondary
Change in Tumor Necrosis Factor Alpha (TNF-α), Interleukin 6 (IL-6), Growth/Differentiation Factor-15 (GDF15) From Baseline to Post-intervention
The mean change of inflammatory biomarkers baseline/week 0 and post-intervention/week 8 was measured using a Luminex panel containing Tumor Necrosis Factor Alpha (TNF-α), Interleukin 6 (IL-6), Growth/Differentiation Factor-15 (GDF15).
Time frame: Week 0, Week 8
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Gratitude Intervention | Change in Tumor Necrosis Factor Alpha (TNF-α), Interleukin 6 (IL-6), Growth/Differentiation Factor-15 (GDF15) From Baseline to Post-intervention | TNF-a (pg/mL) | -2.4 pg/mL | Standard Deviation 5.1 |
| Gratitude Intervention | Change in Tumor Necrosis Factor Alpha (TNF-α), Interleukin 6 (IL-6), Growth/Differentiation Factor-15 (GDF15) From Baseline to Post-intervention | IL-6 (pg/mL) | 3.0 pg/mL | Standard Deviation 4.1 |
| Gratitude Intervention | Change in Tumor Necrosis Factor Alpha (TNF-α), Interleukin 6 (IL-6), Growth/Differentiation Factor-15 (GDF15) From Baseline to Post-intervention | GDF-15 (pg/mL) | 17.4 pg/mL | Standard Deviation 89.4 |
| Attention Control | Change in Tumor Necrosis Factor Alpha (TNF-α), Interleukin 6 (IL-6), Growth/Differentiation Factor-15 (GDF15) From Baseline to Post-intervention | TNF-a (pg/mL) | -0.2 pg/mL | Standard Deviation 1.1 |
| Attention Control | Change in Tumor Necrosis Factor Alpha (TNF-α), Interleukin 6 (IL-6), Growth/Differentiation Factor-15 (GDF15) From Baseline to Post-intervention | IL-6 (pg/mL) | 0.0 pg/mL | Standard Deviation 15.3 |
| Attention Control | Change in Tumor Necrosis Factor Alpha (TNF-α), Interleukin 6 (IL-6), Growth/Differentiation Factor-15 (GDF15) From Baseline to Post-intervention | GDF-15 (pg/mL) | 15.2 pg/mL | Standard Deviation 696.4 |