A Home-Based Mobile Health Intervention to Replace Sedentary Time With Light Physical Activity in Older Cancer Survivors: Randomized Controlled Pilot Trial

Abstract

Background Older cancer survivors are at risk of the development or worsening of both age- and treatment-related morbidity. Sedentary behavior increases the risk of or exacerbates these chronic conditions. Light-intensity physical activity (LPA) is more common in older adults and is associated with better health and well-being. Thus, replacing sedentary time with LPA may provide a more successful strategy to reduce sedentary time and increase physical activity. Objective This study primarily aims to evaluate the feasibility, acceptability, and preliminary efficacy of a home-based mobile health (mHealth) intervention to interrupt and replace sedentary time with LPA (standing and stepping). The secondary objective of this study is to examine changes in objective measures of physical activity, physical performance, and self-reported quality of life. Methods Overall, 54 cancer survivors (aged 60-84 years) were randomized in a 1:1:1 allocation to the tech support intervention group, tech support plus health coaching intervention group, or waitlist control group. Intervention participants received a Jawbone UP2 activity monitor for use with their smartphone app for 13 weeks. Tech support and health coaching were provided via 5 telephone calls during the 13-week intervention. Sedentary behavior and physical activity were objectively measured using an activPAL monitor for 7 days before and after the intervention. Results Participants included survivors of breast cancer (21/54, 39%), prostate cancer (16/54, 30%), and a variety of other cancer types; a mean of 4.4 years (SD 1.6) had passed since their cancer diagnosis. Participants, on average, were 70 years old (SD 4.8), 55% (30/54) female, 24% (13/54) Hispanic, and 81% (44/54) overweight or obese. Malfunction of the Jawbone trackers occurred in one-third of the intervention group, resulting in enrollment stopping at 54 rather than the initial goal of 60 participants. Despite these technical issues, the retention in the intervention was high (47/54, 87%). Adherence was high for wearing the tracker (29/29, 100%) and checking the app daily (28/29, 96%) but low for specific aspects related to the sedentary features of the tracker and app (21%-25%). The acceptability of the intervention was moderately high (81%). There were no significant between-group differences in total sedentary time, number of breaks, or number of prolonged sedentary bouts. There were no significant between-group differences in physical activity. The only significant within-group change occurred within the health coaching group, which increased by 1675 daily steps (95% CI 444-2906; P=.009). This increase was caused by moderate-intensity stepping rather than light-intensity stepping (+15.2 minutes per day; 95% CI 4.1-26.2; P=.008). Conclusions A home-based mHealth program to disrupt and replace sedentary time with stepping was feasible among and acceptable to older cancer survivors. Future studies are needed to evaluate the optimal approach for replacing sedentary behavior with standing and/or physical activity in this population. Trial Registration ClinicalTrials.gov NCT03632694; https://clinicaltrials.gov/ct2/show/NCT03632694

Southwest Harvest for Health: An Adapted Mentored Vegetable Gardening Intervention for Cancer Survivors

“…Secondary outcomes included trends in V and F consumption, physical activity, and HRQOL. The processing of the activPAL data to calculate time spent engaged in physical activities and sedentary activities has been previously described [ 47 ]. All activPAL variables were standardized to a 15-h day to limit the effect of within and between-person variability in awake/wear time.…”

“You’re Going to Have to Think a Little Bit Different” Barriers and Facilitators to Using mHealth to Increase Physical Activity among Older, Rural Cancer Survivors

“…We asked participants what types of technologies they used, the support they would need to use a WAT, and interest in this type of project. Based on a previous study by the principle investigator with older cancer survivors in urban, clinic-based setting in NM [20], we were interested specifically in Fitbit for the future intervention. We passed around a Fitbit Alta HR for participants to examine and showed them screenshots of the app.…”

“…Mobile health (mHealth) technologies, including consumer wearable activity trackers (WATs) and companion smartphone apps, have great promise in overcoming the limitations of in-person interventions to increase physical activity and reduce sedentary behaviors in older cancer survivors [20]. Studies revealed that WATs can provide behavioral modification strategies including self-monitoring, feedback, and goal setting, and that they are associated with behavior change in different populations [21][22][23], including cancer survivors [24][25][26].…”

“…Moreover, studies did not target either rural or older cancer survivors [26][27][28]. Studies that examined acceptability of WATs in older adults documented the need to support their use of technology [20,29]. Recent pilot studies also show promise in WATs-based interventions among older rural individuals in Australia [30,31] and in Korea [32].…”

Light‐intensity and moderate‐to‐vigorous intensity physical activity among older adult breast cancer survivors with obesity: A narrative review

“… 52 , 53 Similar to other physical activity interventions, depending on inclusion criteria, such as baseline activity levels, LIPA RCTs may struggle to actually increase LIPA. 53 …”