Effectiveness of a Self-Monitoring App in Supporting Physical Activity Maintenance Among Rural Canadians With Cancer After an Exercise Oncology Program: Cluster Randomized Controlled Trial

Abstract

Background Despite the benefits of physical activity (PA) for individuals with cancer, most remain insufficiently active. Exercise oncology interventions can improve PA levels. Individuals struggle to maintain PA levels after interventions because of persistent psychological and environmental PA barriers. Health technology (eHealth) may address some PA barriers and deliver effective, scalable PA interventions in oncology, yet its effectiveness for changing PA levels remains mixed. Using eHealth to support PA maintenance among rural populations with cancer, who may need greater PA support given lower PA levels and worse health outcomes, remains under-studied. Objective This study examined the effectiveness of an app-based self-monitoring intervention in supporting PA maintenance among rural populations with cancer after a supervised web-based exercise oncology program. Methods This 2-arm, cluster randomized controlled trial was embedded within the Exercise for Cancer to Enhance Living Well (EXCEL) effectiveness-implementation study. Upon consent, participants were randomized 1:1 by EXCEL class clusters to the intervention (24 weeks of app-based PA self-monitoring) or waitlist control (app access after 24 weeks). Both groups completed a 12-week supervised web-based exercise oncology program followed by a 12-week self-directed PA maintenance period. Baseline demographics, eHealth literacy, and patient-reported outcomes were compared using chi-square and 2-tailed t tests. App use was measured throughout the intervention. The primary outcome—self-reported moderate-to-vigorous PA (MVPA) minutes—and secondary outcomes—objective MVPA minutes and steps and app usability ratings—were collected at baseline, 12 weeks, and 24 weeks. Intervention effects on self-report MVPA maintenance were assessed via linear mixed modeling, with secondary outcomes explored descriptively. Results Of the 359 eligible EXCEL participants, 205 (57.1%) consented, 199 (55.4%; intervention: 106/199, 53.3%; control: 93/199, 46.7%) started the study, and 183 (51%; intervention: 100/183, 54.6%; control: 83/183, 45.4%) and 141 (39.3%; intervention: 69/141, 48.9%; control: 72/141, 51.1%) completed 12- and 24-week measures, respectively. Mean age was 57.3 (SD 11.5) years. Most participants were female (174/199, 87.4%), White (163/199, 81.9%), and diagnosed with breast cancer (108/199, 54.3%). Median baseline self-report weekly MVPA minutes were 60.0 (IQR 0-180) and 40.0 (IQR 0-135) for the intervention and waitlist control groups, respectively (P=.74). Median app use duration was 10.3 (IQR 1.3-23.9) weeks, with 9.6 (IQR 4.4-17.8) self-monitoring entries/week. Both groups increased their weekly MVPA minutes significantly at 12 weeks (P<.001) and maintained the increases at 24 weeks (P<.001), relative to baseline, with no between-group differences (P=.87). The intervention group had significantly higher step counts for 7 of the 12 weeks during the PA maintenance period (P=.048 to <.001). Conclusions The app-based self-monitoring intervention did not improve MVPA maintenance but may have contributed to increased step counts during the PA maintenance period. More work is needed to realize the full potential of eHealth in exercise oncology. Trial Registration ClinicalTrials.gov NCT04790578; https://clinicaltrials.gov/study/NCT04790578 International Registered Report Identifier (IRRID) RR2-10.1016/j.cct.2021.106474

Behavior Change Techniques for the Maintenance of Physical Activity in Cancer

“…Nonetheless, <25% of RCTs of exercise in cancer report significant between-group differences in PA when measured a minimum of 6 months following program completion [ 3 ]. The findings of this cluster RCT are similar [ 1 ]. Furthermore, in the intervention group, the addition of 23 weeks of app-based PA monitoring to the program did not cause significant between-group differences in self-reported moderate to vigorous physical activity at 6 months.…”

“…Ester et al [ 1 ] recently report findings from a 2-arm cluster randomized controlled trial (RCT) nested within a hybrid effectiveness-implementation study providing rural and remote Canadians access to a 12-week exercise and behavior change program (Exercise for Cancer to Enhance Living Well [EXCEL]). Maintenance of physical activity (PA) behaviors beyond the completion of an exercise program is challenging for both healthy individuals and those with chronic health conditions including cancer.…”

Perspectives on Ease of Use and Value of a Self-Monitoring Application to Support Physical Activity Maintenance among Individuals Living with and beyond Cancer

“…The study had several limitations. Despite the use of purposive sampling, the larger exercise oncology intervention from which we invited participants lacked variation in ethnicity and education level [ 33 , 34 , 35 ]. Most participants were female, white, and had moderate–high incomes and education levels.…”

“…Participants were recruited from the intervention group of a 2-arm cluster randomized controlled trial (RCT) of an app-based self-monitoring intervention to support PA maintenance (i.e., long-term PA habits up to and beyond 24 weeks), which was embedded within the Exercise for Cancer to Enhance Living well (EXCEL) effectiveness-implementation study [ 33 , 34 , 35 ]. The RCT was prospectively registered and its protocol was published prior to the study starting (NCT 04790578) [ 33 ].…”

“…He was personally invested in the study as part of his doctoral degree project, interacting directly with participants as the study coordinator during the 6-month PA intervention period prior to conducting interviews. The author’s prior interview experience includes qualitative research among advanced lung cancer populations and leading patient advisory board meetings within the EXCEL study [ 33 , 34 , 35 ].…”