Date of Award

January 2024

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Brenda Cartmel

Second Advisor

Leah Ferrucci


Background: Lifestyle interventions can be an important tool in improving quality of life (QOL) among breast cancer survivors. Anxiety has been improved in some, but not all, exercise or lifestyle interventions that have investigated this component of QOL. Therefore, we sought to examine the impact of the 6-month Lifestyle, Exercise, and Nutrition (LEAN) intervention vs. usual care on anxiety among women who completed treatment for breast cancer. Methods: A total of 151 breast cancer survivors participated in the LEAN study, and 116 participants were included in this secondary analysis. State anxiety was assessed via the state anxiety portion of the State-Trait Anxiety Inventory (STAI) at baseline and 6-months. The STAI state anxiety score ranges from 20 to 80, with higher scores indicating greater anxiety. We examined change in state anxiety from baseline to 6-months by study arm using a paired t-test. Results: Despite a significant improvement in state anxiety from baseline to 6-months in the intervention arm (-4.3; p=0.001), there was no statistically significant difference in the change in state anxiety by study arm at 6-months (p=0.11). Among the intervention arm, items of ease and worry demonstrated the highest absolute mean change from baseline to 6-month. Conclusion: The LEAN intervention did not have a significant impact on state anxiety among breast cancer survivors. However, anxiety scores in the intervention arm changed in an improved direction. Future lifestyle interventions should consider incorporating content that addresses anxiety as well as other components of QOL to potentially improve multiple outcomes among breast cancer survivors.


This is an Open Access Thesis.

Open Access

This Article is Open Access