Feasibility and Acceptability of an Active Video Game–Based Physical Activity Support Group (Pink Warrior) for Survivors of Breast Cancer: Randomized Controlled Pilot Trial

Abstract

Background Survivors of breast cancer with functional limitations have a 40% higher mortality rate than those without. Despite the known benefits of physical activity (PA), <40% of survivors of breast cancer meet the recommendations for PA. The combination of active video games (AVGs) and group-based PA counseling may hold potential for motivating PA adoption and improving physical function. However, this method has not been widely studied in survivors of breast cancer. Objective We aimed to determine the feasibility and acceptability of a group AVG-based multicomponent PA intervention and estimate its effect size and variability on PA and physical function in female survivors of breast cancer in a clinic setting. Methods Female survivors of breast cancer (N=60) were recruited through the clinic and randomly assigned to the intervention group (12 weekly sessions) or the control group (existing support group). The intervention group received game-based pedometers and participated in weekly group AVG sessions, PA behavioral coaching, and survivorship navigation discussions. A participant manual with weekly reflection worksheets was provided to reinforce the coaching lessons and promote self-led PA. The control group received conventional pedometers and participated in an existing breast cancer support group. Feasibility was assessed by enrollment rate (≥50%), retention rate (≥80%), group attendance rate (75% attending ≥9 sessions [intervention group]), and the number of technological issues and adverse events. Acceptability was measured by participants’ attitudes (from strongly disagree=1 to strongly agree=5) toward the use of AVGs and the overall program. The outcomes included PA (accelerometers) and physical function (Short Physical Performance Battery and gait speed). Analysis of covariance was used to determine differences in PA and physical function between the groups. The Cohen d and its 95% CI determined the effect size and variability, respectively. All the analyses followed the intention-to-treat principle. Results Participants were an average of 57.4 (SD 10.5) years old, 70% (42/60) White, and 58% (35/60) off treatment. The enrollment rate was 55.9% (66/118). Despite substantial long-term hurricane-related disruptions, we achieved an 80% (48/60) retention. The intervention group’s attendance rate was 78% (14/18), whereas the control group’s attendance rate was 53% (9/17). Of the 26 game-based pedometers, 3 (12%) were damaged or lost. No study-related adverse events occurred. Acceptability items were highly rated. Steps (β=1621.64; P=.01; d=0.72), Short Physical Performance Battery (β=.47; P=.01; d=0.25), and gait speed (β=.12; P=.004; d=0.48) had a significant intervention effect. Conclusions The intervention was feasible and acceptable in this population despite the occurrence of a natural disaster. Pilot results indicate that group AVG sessions, PA coaching, and survivorship navigation produced moderate effects on PA and physical functioning. AVGs with PA counseling can potentially be used in existing breast cancer support groups to encourage PA and improve physical function. Trial Registration ClinicalTrials.gov NCT02750241; https://clinicaltrials.gov/ct2/show/NCT02750241

Assessing the Suitability of a Virtual ‘Pink Warrior’ for Older Breast Cancer Survivors during COVID-19: A Pilot Study

“…The attention control group participated in weekly telephone and group-based BC support using the BC support discussion materials. The randomization process described by Lyons et al was used in the current study [ 19 , 35 ]. Briefly, a graduate student who did not assist with the assessments used a web-based app [ 19 , 36 ] to produce a random sequence of treatment assignment to intervention or attention control group using a 1:1 allocation strategy.…”

“…The randomization process described by Lyons et al was used in the current study [ 19 , 35 ]. Briefly, a graduate student who did not assist with the assessments used a web-based app [ 19 , 36 ] to produce a random sequence of treatment assignment to intervention or attention control group using a 1:1 allocation strategy. Each assignment was recorded on a single piece of paper.…”

“…We previously tested the feasibility of promoting PA in an in-person group setting using exergames along with PA behavioral coaching and BC support discussions among survivors of BC aged 18 years and older [ 19 ]. PA behavioral coaching was designed to provide self-management skills to overcome PA-related barriers [ 19 ]. Exergame was chosen as a tool to promote PA to help reframe PA as a pleasurable activity [ 20 , 21 ].…”

“…Accumulating evidence indicates that targeting a person’s motivation and reframing the internal reaction to PA as a fun activity may lead to a more effective intervention [ 22 , 23 , 24 , 25 , 26 , 27 ]. Our pilot study’s results indicated high levels of acceptance of using exergames and being active in a group setting [ 19 ]. Similar to Wurz and colleagues’ findings, feedback from survivors indicated that attending in-person sessions remained a barrier for survivors in all stages of their cancer care continuum (e.g., limited ability to travel because of cancer treatment side effects, traffic) [ 13 ].…”

“…Additionally, the COVID-19 pandemic also significantly impacted the conduct and participation of in-person PA interventions targeting medically complex populations, such as older survivors of BC [ 29 ]. Thus, we adapted a previously tested exergame- and group-based PA intervention [ 19 ] to be delivered via videoconference platform. We also adapted our physical function assessments to be conducted via a videoconference platform [ 30 , 31 ].…”