Current Evidence and Directions for Future Research in eHealth Physical Activity Interventions for Adults Affected by Cancer: Systematic Review

Abstract

Background Physical activity (PA) interventions can increase PA and improve well-being among adults affected by cancer; however, most adults do not meet cancer-specific PA recommendations. Lack of time, facility access, and travel distances are barriers to participation in PA interventions. eHealth technologies may address some of these barriers, serving as a viable way to promote PA behavior change in this population. However, no review from July 2018 has synthesized available evidence across eHealth and cancer types or examined the use of behavioral theory and behavior change techniques (BCTs), leaving important gaps in knowledge. Objective This review aims to provide a comprehensive, updated overview of evidence on eHealth PA interventions for adults with cancer by describing the current state of the literature, exploring associations between intervention characteristics and effectiveness, and identifying future research needs. Methods MEDLINE, Embase, CINAHL, SportDiscus, Scopus, and CENTRAL were searched for eHealth PA interventions for adults affected by cancer. Study selection and data extraction were performed in duplicate, with consultation from the senior author (NCR). BCT coding, risk of bias, and completeness of reporting were performed using standardized tools. Results were summarized via narrative synthesis and harvest plots. Weight analyses were conducted to explore the associations between intervention characteristics and effectiveness. Results A total of 71 articles (67 studies) involving 6655 participants (mean age 56.7 years, SD 8.2) were included. Nearly 50% (32/67) of the articles were published after July 2018. Significant postintervention PA increases were noted in 52% (35/67) of the studies, and PA maintenance was noted in 41% (5/12) of the studies that included a follow-up. Study duration, primary objectives, and eHealth modality (eg, websites, activity trackers, and SMS text messaging) varied widely. Social cognitive theory (23/67, 34%) was the most used theory. The mean number of BCTs used across the studies was 13.5 (SD 5.5), with self-monitoring, credible sources, and goal setting being used in >90% of studies. Weight analyses showed the greatest associations between increased PA levels and PA as a primary outcome (0.621), interventions using websites (0.656) or mobile apps (0.563), interventions integrating multiple behavioral theories (0.750), and interventions using BCTs of problem solving (0.657) and action planning (0.645). All studies had concerns with high risk of bias, mostly because of the risk of confounding, measurement bias, and incomplete reporting. Conclusions A range of eHealth PA interventions may increase PA levels among adults affected by cancer, and specific components (eg, websites, use of theory, and action planning) may be linked to greater effectiveness. However, more work is needed to ascertain and optimize effectiveness, measure long-term effects, and address concerns with bias and incomplete reporting. This evidence is required to support arguments for integrating eHealth within PA promotion in oncology.

Feasibility of a tailored and virtually supported home exercise program for people with multiple myeloma using a novel eHealth application

“… 20 Indeed, a recent review on eHealth interventions in cancer proposed videoconferencing as a way to deliver accessible, virtually supervised interventions. 22 In the current study, supervision involved weekly virtually supervised workouts in small group settings and regular participant/specialist check-ins using videoconferencing through HEAL-Me. This allowed for live feedback on exercise form/technique and facilitated discussions that informed exercise adaptations and tailored education/advice.…”

“…Indeed, eHealth interventions are being increasingly researched in the field of exercise oncology. 22 Recent trials have found eHealth interventions to be feasible and acceptable in older adults with cancer, 23 , 24 individuals with thoracoabdominal malignancies, 25 and individuals with metastatic prostate cancer. 26 Other trials identify the promise of eHealth interventions for outcomes such as fatigue, strength, pain, and functional capacity in various cancer populations.…”

Virtual Prehabilitation in Patients With Cancer Undergoing Surgery During the COVID-19 Pandemic: Protocol for a Prospective Feasibility Study

“…Teleprehabilitation was defined in a previously published commentary by our group in 2020 [ 5 ] as the use of technologies to deliver health interventions to patients prior to surgery. Briefly, the commentary elaborated on the benefits and opportunities of using various technological tools available [ 14 , 15 ]. The commentary suggested that combined systems of videoconferencing and wearable devices may be optimal in providing personalized feedback [ 5 ].…”

Let’s build an app for that

“…Effective PA interventions for adults with cancer include in-person and home-based programs, individual and group formats, and interventions that feature technology-based behavior change support (Ester, Eisele, et al, 2021;Sheeran et al, 2019). In line with the ever-increasing popularity and capability of internet-connected devices, efforts to use technology to support PA behavior change are gaining attention (Vandelanotte et al, 2016).…”

“…As a result, research and development related to PA mobile apps for adults with cancer and other populations has seen rapid growth in recent years (Chan et al, 2020b;Ester, Eisele, et al, 2021;Vandelanotte et al, 2016). For all those who have toyed with the idea, this viewpoint article details the authors' recent experiences with app development in exercise oncology and presents recommendations for future work in this field.…”