mHealth system (ATOPE+) to support exercise prescription in breast cancer survivors: a reliability and validity, cross-sectional observational study (ATOPE study)

Abstract

Physical exercise is known to be beneficial for breast cancer survivors (BCS). However, avoiding nonfunctional overreaching is crucial in this population, as they are in physiological dysregulation. These factors could decrease their exercise capacity or facilitate nonfunctional overreaching, which can increase their risk of additional morbidities and even all-cause mortality. The focus of this study is to evaluate the reliability and validity of the ATOPE+ mHealth system to estimate autonomic balance and specific wellness parameters associated with BCS’ perceived load, thereby informing nonlinear prescriptions in individualized physical exercise programs for BCS.Twenty-two BCS were included in the reliability and validity analysis. Measures were taken for four days, including morning autonomic balance by heart rate variability, self-reported perception of recovery from exercise, sleep satisfaction, emotional distress and fatigue after exertion. Measures were taken utilizing the ATOPE+ mHealth system application. The results of these measures were compared with criterion instruments to assess validity.The reliability results indicated that the intraclass correlation coefficient (ICC) showed an excellent correlation for recovery (0.93; 95% CI 0.85–0.96) and distress (0.94, 95% CI 0.89–0.97) as well as good correlation for the natural logarithm of the mean square root differences of the standard deviation (LnRMSSD) (0.87; 95% CI 0.74–0.94). Sleep satisfaction also showed an excellent correlation with a weighted kappa of 0.83. The validity results showed no significant differences, except for fatigue. ATOPE+ is reliable and valid for remotely assessing autonomic balance, perception of recovery, sleep satisfaction and emotional distress in BCS; however, it is not for fatigue. This highlights that ATOPE+ could be an easy and efficient system used to assess readiness in BCS, and could help to improve their health by supporting the prescription of optimal and safe physical exercise. Trial registration NCT03787966 ClinicalTrials.gov, December 2019 [ATOPE project]. https://clinicaltrials.gov/ct2/show/NCT03787966.

Nonlinear, Multicomponent Physical Exercise With Heart Rate Variability-Guided Prescription in Women With Breast Cancer During Treatment: Feasibility and Preliminary Results (ATOPE Study)

“…The ATOPE+ mHealth system 40 was designed to measure HRV with a heart rate chest band (Polar H10 Heart Rate Monitor, Finland) and self-reported responses with electronic patient-reported outcome measures (ePROMS) such as sleep (satisfaction and duration), physical exercise recovery, and distress. All ePROMS were validated in a previous study.…”

“…All ePROMS were validated in a previous study. 40 The ATOPE+ mHealth system has shown good reliability when assessed against gold standard tools. 40 During the ATOPE program, the women had to use the ATOPE + mHealth system each morning (7 days per week), which established a physical exercise intensity recommendation for the day through an algorithm that considers different cutoff points for HRV, recovery perception, sleep satisfaction, fatigue, and emotional distress.…”

“… 40 The ATOPE+ mHealth system has shown good reliability when assessed against gold standard tools. 40 During the ATOPE program, the women had to use the ATOPE + mHealth system each morning (7 days per week), which established a physical exercise intensity recommendation for the day through an algorithm that considers different cutoff points for HRV, recovery perception, sleep satisfaction, fatigue, and emotional distress. 40 The system sets recommendations for active rest (walking until daily goal steps are reached) or physical exercise sessions with moderate or vigorous intensity.…”

“…The ATOPE+ mHealth system 39 , 40 is a novel tool that records HRV and clinimetric measurements (perception of recovery, sleep satisfaction, and emotional distress), allowing for an assessment of the daily recovery status of an individual, and then provides individualized daily physical activity or exercise recommendations. Therefore, the purpose of this study was to analyze the feasibility, safety, and compliance rate of the ATOPE program as well as examine the difference in associated changes in women undergoing RT and CT.…”

PaiNEd app. Assessing central sensitization in survivors of breast cancer: A reliability study

“…Some previous mHealth apps have been successfully tested in the oncological context. An example of this would be the ATOPE + mHealth system, 13 which is a reliable and valid tool that monitors readiness in sBCs, allowing physiotherapists to prescribe safer and more optimal doses of exercise. Another example is BENECA mHealth, which is also a reliable and valid mHealth app 14 that changes the lifestyles of sBCs through monitoring energy balance (healthy eating and physical activity).…”