The Acceptability of an Electronically Delivered Acceptance- and Mindfulness-Based Physical Activity Intervention for Survivors of Breast Cancer: One-Group Pretest-Posttest Design

Robertson, Michael C; Cox-Martin, Emily; Shegog, Ross; Markham, Christine; Fujimoto, Kayo; Durand, Casey P.; Brewster, Abenaa M.; Lyons, Elizabeth; Liao, Yue; Flores, Sara; Basen-Engquist, Karen

doi:10.2196/31815

Cited by 4 publications

(5 citation statements)

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“…Participants' comments in this study suggested that although many enjoyed the introspective aspects of the intervention, some did not. This observation is concordant with high ratings of acceptability in the parent study for those who completed the study but a less-than-ideal dropout rate (23.7%) [23]. Achieving deeper levels of reflection may have a dynamic and, in some contexts, diametrically opposed relationship with affective or subjective experiences.…”

Section: Comparison With Previous Literaturesupporting

confidence: 60%

“…We conducted a secondary analysis on data obtained from a 1-group pilot study. The purpose of the parent study was to evaluate the acceptability of an acceptance-and mindfulness-based intervention to increase physical activity in survivors of breast cancer [23]. This study is an investigation of the use of the intervention.…”

Section: Methodsmentioning

confidence: 99%

“…We found participants' average depth of retrospective reflection to be associated with more integrated regulation for physical activity and cognitive acceptance in the context of physical activity but not with other outcomes of interest. It is encouraging that deeper levels of reflection on intervention content were associated with beneficial changes in motivation and physical activity acceptance, given that these were the theory-informed psychosocial constructs that the DBCI targeted [23]. The cognitive acceptance of physical activity has been shown to be associated with long-term changes in objectively measured physical activity, and integrated regulation is similarly predictive of physical activity [45,56].…”

Section: Comparison With Previous Literaturementioning

confidence: 99%

“…The intervention has been described in detail elsewhere [23]. Briefly, the ACTive program was an 8-week DBCI designed to help insufficiently active survivors of breast cancer increase moderate-intensity aerobic and muscle-strengthening physical activity.…”

Section: Intervention Descriptionmentioning

confidence: 99%

“…Furthermore, physical activity interventions that simultaneously target both health-related behaviors and quality-of-life issues are more effective at achieving sustained physical activity outcomes than interventions that only promote physical activity for this population [18]. Emerging evidence suggests that acceptanceand mindfulness-based physical activity interventions can be feasible and effective at promoting physical activity [19][20][21] and that digitally delivered approaches can be acceptable and potentially effective for people living with and beyond cancer [22,23].…”

Section: Introductionmentioning

confidence: 99%

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Reflective Engagement With a Digital Physical Activity Intervention Among People Living With and Beyond Breast Cancer: Mixed Methods Study

Robertson,

Cox-Martin,

Basen-Engquist

et al. 2024

JMIR Mhealth Uhealth

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Background People living with and beyond breast cancer can face internal barriers to physical activity (eg, fatigue and pain). Digital interventions that promote psychological acceptance and motivation may help this population navigate these barriers. The degree to which individuals (1) adhere to intervention protocols and (2) reflect on and internalize intervention content may predict intervention efficacy. Objective The objective of this study was to characterize the nature of reflective processes brought about by an 8-week acceptance- and mindfulness-based physical activity intervention for insufficiently active survivors of breast cancer (n=75). Furthermore, we explored the potential utility of a metric of reflective processes for predicting study outcomes. Methods Of the intervention’s 8 weekly modules, 7 (88%) included an item that asked participants to reflect on what they found to be most useful. Two coders conducted directed content analysis on participants’ written responses. They assessed each comment’s depth of reflection using an existing framework (ranging from 0 to 4, with 0=simple description and 4=fundamental change with consideration of social and ethical issues). The coders identified themes within the various levels of reflection. We fit multiple linear regression models to evaluate whether participants’ (1) intervention adherence (ie, number of modules completed) and (2) the mean level of the depth of reflection predicted study outcomes. Results Participants were aged on average 57.2 (SD 11.2) years, mostly non-Hispanic White (58/75, 77%), and mostly overweight or obese (54/75, 72%). Of the 407 responses to the item prompting personal reflection, 70 (17.2%) were rated as reflection level 0 (ie, description), 247 (60.7%) were level 1 (ie, reflective description), 74 (18.2%) were level 2 (ie, dialogic reflection), 14 (3.4%) were level 3 (ie, transformative reflection), and 2 (0.5%) were level 4 (ie, critical reflection). Lower levels of reflection were characterized by the acquisition of knowledge or expressing intentions. Higher levels were characterized by personal insight, commentary on behavior change processes, and a change of perspective. Intervention adherence was associated with increases in self-reported weekly bouts of muscle-strengthening exercise (B=0.26, SE 0.12, 95% CI 0.02-0.50) and decreases in sleep disturbance (B=−1.04, SE 0.50, 95% CI −0.06 to −2.02). The mean level of reflection was associated with increases in psychological acceptance (B=3.42, SE 1.70, 95% CI 0.09-6.75) and motivation for physical activity (ie, integrated regulation: B=0.55, SE 0.25, 95% CI 0.06-1.04). Conclusions We identified a useful method for understanding the reflective processes that can occur during digital behavior change interventions serving people living with and beyond breast cancer. Intervention adherence and the depth of reflection each predicted changes in study outcomes. Deeper reflection on intervention content was associated with beneficial changes in the determinants of sustained behavior change. More research is needed to investigate the relations among digital behavior change intervention use, psychological processes, and intervention efficacy.

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Section: Comparison With Previous Literaturesupporting

confidence: 60%

Section: Methodsmentioning

confidence: 99%

Section: Comparison With Previous Literaturementioning

confidence: 99%

Section: Intervention Descriptionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Reflective Engagement With a Digital Physical Activity Intervention Among People Living With and Beyond Breast Cancer: Mixed Methods Study

Robertson,

Cox-Martin,

Basen-Engquist

et al. 2024

JMIR Mhealth Uhealth

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Feasibility study of a mobile application (ACT-ON) to complement acceptance and commitment therapy (ACT) intervention in cancer patients

García-Torres

García-Carmona

García

et al. 2023

International Journal of Medical Informatics

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Internet-delivered Acceptance and Commitment Therapy for Cancer Patients and Survivors: A Systematic Review

García-Torres,

García-Carmona,

Moreno

et al. 2024

Sage Open

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Acceptance and commitment therapy (ACT) has proven effective in cancer patients, reducing common psychological symptoms and improving wellbeing. Moreover, the use of eHealth technologies makes support cheaper and easier to provide. The aim of this systematic review was to collect results on the effectiveness of internet-delivered ACT for common symptoms in cancer patients and survivors. The review follows PRISMA guidance and was registered in PROSPERO (CRD42022326543). Searches were conducted using PubMed, Web of Science, Scopus, EBSCOhost, and different web platforms of grey literature. Interventional studies were selected which focused on cancer patients and survivors, were published in English or Spanish, included at least two of the six main ACT components, and were partially or fully delivered through the Internet. The risk of bias was assessed following Cochrane’s recommendations. Eleven records from seven studies met the inclusion criteria. Only one study showed significant reductions in anxiety (reliable change index, RCI∈ [2.32, 3.47]) and depression ( RCI∈ [2.00, 4.00]). As regards quality of life, significant improvements were observed in certain domains such as cancer-related quality of life ( RCI = 2.43), fatigue ( d = −0.33), sleep problems ( d = −0.53), physical and functional wellbeing (η2 p = .06), and participation in social activities ( d = 0.18). ACT processes resulted in significant post-intervention improvements with regard to mindfulness ability and psychological flexibility. Results look promising; however, we believe that limitations such as blinding issues, the heterogeneity of designs and measurement tools, or the use of monetary incentives should be taken into account in future research.

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The Acceptability of an Electronically Delivered Acceptance- and Mindfulness-Based Physical Activity Intervention for Survivors of Breast Cancer: One-Group Pretest-Posttest Design

Cited by 4 publications

References 80 publications

Reflective Engagement With a Digital Physical Activity Intervention Among People Living With and Beyond Breast Cancer: Mixed Methods Study

Reflective Engagement With a Digital Physical Activity Intervention Among People Living With and Beyond Breast Cancer: Mixed Methods Study

Feasibility study of a mobile application (ACT-ON) to complement acceptance and commitment therapy (ACT) intervention in cancer patients

Internet-delivered Acceptance and Commitment Therapy for Cancer Patients and Survivors: A Systematic Review

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