Skip to main content

Advertisement

SpringerLink
Log in

Feasibility of a behavioral intervention using mobile health applications to reduce cardiovascular risk factors in cancer survivors: a pilot randomized controlled trial

  • Published:
Journal of Cancer Survivorship Aims and scope Submit manuscript

Abstract

Purpose

Determine the feasibility of a remotely delivered mobile health (mHealth)-supported intervention to improve diet and physical activity in hematologic malignancy survivors.

Methods

Pilot randomized controlled trial of a 16-week intervention for improving diet and physical activity: individualized goal-setting (daily steps, sodium, saturated fat, added sugar intake) per feedback from mHealth trackers (Fitbit for activity; Healthwatch360 for diet), supplemented by a Facebook peer support group. Controls accessed the trackers without goal-setting or peer support. Everyone received standardized survivorship counseling with tailored advice from a clinician. Actigraphy and food frequency questionnaires assessed activity and diet at baseline and follow-up.

Results

Forty-one participants (51.2% male; median age 45.1 years; 7.0 years from treatment) were randomized (24 intervention; 17 control). Fitbit and Healthwatch360 use were more common among intervention versus control participants (75.0% versus 70.6% and 50.0% versus 17.7% of eligible days, respectively). Most intervention participants (66.7%) engaged with Facebook; overall, 91.7% interacted with the study’s mHealth applications. While no comparisons in activity or dietary outcomes between intervention versus control group met statistical significance, the intervention was associated with greater reductions in the targeted dietary factors and improvements in Healthy Eating Index-2015 score, moderate-vigorous physical activity time, and daily steps. Participant retention at 6 months was 90.2%.

Conclusions

An intervention for cardiovascular risk reduction based on individualized goal-setting enhanced by mHealth and social media peer support was feasible and acceptable among cancer survivors.

Implications for Cancer Survivors

Effective and easily disseminated strategies that improve diet and physical activity in this population are needed.

Trial registration

Registered in ClinicalTrials.gov (NCT03574012) on June 29, 2018.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Hull MC, Morris CG, Pepine CJ, Mendenhall NP. Valvular dysfunction and carotid, subclavian, and coronary artery disease in survivors of Hodgkin lymphoma treated with radiation therapy. JAMA. 2003;290(21):2831–7.

    CAS  PubMed  Google Scholar 

  2. Baker KS, Ness KK, Steinberger J, Carter A, Francisco L, Burns LJ, et al. Diabetes, hypertension, and cardiovascular events in survivors of hematopoietic cell transplantation: a report from the bone marrow transplantation survivor study. Blood. 2007;109(4):1765–72.

    CAS  PubMed  Google Scholar 

  3. Tichelli A, Bhatia S, Socie G. Cardiac and cardiovascular consequences after haematopoietic stem cell transplantation. Br J Haematol. 2008;142(1):11–26.

    PubMed  Google Scholar 

  4. Chow EJ, Baker KS, Lee SJ, Flowers ME, Cushing-Haugen KL, Inamoto Y, et al. Influence of conventional cardiovascular risk factors and lifestyle characteristics on cardiovascular disease after hematopoietic cell transplantation. J Clin Oncol. 2014;32(3):191–8.

    PubMed  Google Scholar 

  5. Leger KJ, Baker KS, Cushing-Haugen KL, Flowers MED, Leisenring WM, Martin PJ, et al. Lifestyle factors and subsequent ischemic heart disease risk after hematopoietic cell transplantation. Cancer. 2018;124(7):1507–15.

    PubMed  Google Scholar 

  6. Schoeppe S, Alley S, Van Lippevelde W, Bray NA, Williams SL, Duncan MJ, et al. Efficacy of interventions that use apps to improve diet, physical activity and sedentary behaviour: a systematic review. Int J Behav Nutr Phys Act. 2016;13(1):127.

    PubMed  PubMed Central  Google Scholar 

  7. Balatsoukas P, Kennedy CM, Buchan I, Powell J, Ainsworth J. The role of social network technologies in online health promotion: a narrative review of theoretical and empirical factors influencing intervention effectiveness. J Med Internet Res. 2015;17(6):e141.

    PubMed  PubMed Central  Google Scholar 

  8. Teixeira PJ, Carraca EV, Markland D, Silva MN, Ryan RM. Exercise, physical activity, and self-determination theory: a systematic review. Int J Behav Nutr Phys Act. 2012;9:78.

    PubMed  PubMed Central  Google Scholar 

  9. Teixeira PJ, Carraca EV, Marques MM, Rutter H, Oppert JM, De Bourdeaudhuij I, et al. Successful behavior change in obesity interventions in adults: a systematic review of self-regulation mediators. BMC Med. 2015;13:84.

    PubMed  PubMed Central  Google Scholar 

  10. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24(1):67–74.

    CAS  PubMed  Google Scholar 

  11. Godin G, Jobin J, Bouillon J. Assessment of leisure time exercise behavior by self-report: a concurrent validity study. Can J Public Health. 1986;77(5):359–62.

    CAS  PubMed  Google Scholar 

  12. Centers for Disease Control and Prevention. Behavioral risk factor surveillance system. http://www.cdc.gov/brfss/. Accessed 1 July 2020.

  13. Schwarzer R, Luszczynska A. Self-efficacy. http://cancercontrol.cancer.gov/brp/research/constructs/self_efficacy.html. Accessed 1 July 2020.

  14. Markland D, Tobin V. A modification to the behavioural regulation in exercise questionnaire to include an assessment of amotivation. J Sport Exerc Psychol. 2004;26(2):191–6.

    Google Scholar 

  15. Hearty AP, McCarthy SN, Kearney JM, Gibney MJ. Relationship between attitudes towards healthy eating and dietary behaviour, lifestyle and demographic factors in a representative sample of Irish adults. Appetite. 2007;48(1):1–11.

    CAS  PubMed  Google Scholar 

  16. Patterson RE, Kristal AR, Tinker LF, Carter RA, Bolton MP, Agurs-Collins T. Measurement characteristics of the Women’s Health Initiative food frequency questionnaire. Ann Epidemiol. 1999;9(3):178–87.

    CAS  PubMed  Google Scholar 

  17. Trost SG, McIver KL, Pate RR. Conducting accelerometer-based activity assessments in field-based research. Med Sci Sports Exerc. 2005;37(11 Suppl):S531–43.

    PubMed  Google Scholar 

  18. Sasaki JE, John D, Freedson PS. Validation and comparison of ActiGraph activity monitors. J Sci Med Sport. 2011;14(5):411–6.

    PubMed  Google Scholar 

  19. Committee on Cancer Survivorship. Improving Care and Quality of Life, National Cancer Policy Board. From cancer patient to cancer survivor: lost in transition. In: Hewitt M, Greenfield S, Stovall E, editors. . Washington, D.C: Institute of Medicine and National Research Council, National Academies Press; 2006.

    Google Scholar 

  20. Schulman-Green D, Bradley EH, Knobf MT, Prigerson H, DiGiovanna MP, McCorkle R. Self-management and transitions in women with advanced breast cancer. J Pain Symptom Manag. 2011;42(4):517–25.

    Google Scholar 

  21. Bricker JB, Watson NL, Mull KE, Sullivan BM, Heffner JL. Efficacy of smartphone applications for smoking cessation: a randomized clinical trial. JAMA Intern Med. 2020. https://doi.org/10.1001/jamainternmed.2020.4055.

    Article  PubMed  PubMed Central  Google Scholar 

  22. O'Connor M, Whelan R, Bricker J, McHugh L. Randomized controlled trial of a smartphone application as an adjunct to acceptance and commitment therapy for smoking cessation. Behav Ther. 2020;51(1):162–77.

    PubMed  Google Scholar 

  23. Van Horn L, Carson JA, Appel LJ, Burke LE, Economos C, Karmally W, et al. Recommended dietary pattern to achieve adherence to the American Heart Association/American College of Cardiology (AHA/ACC) guidelines: a scientific statement from the American Heart Association. Circulation. 2016;134(22):e505–e29.

    PubMed  Google Scholar 

  24. Miropolsky EM, Baker KS, Abbey-Lambertz M, Syrjala K, Chow EJ, Ceballos R, et al. Participant perceptions on a Fitbit and Facebook intervention for young adult cancer survivors: a qualitative study. J Adolesc Young Adult Oncol. 2020;9(3):410–7.

    PubMed  PubMed Central  Google Scholar 

  25. Mendoza JA, Baker KS, Moreno MA, Whitlock K, Abbey-Lambertz M, Waite A, et al. A Fitbit and Facebook mHealth intervention for promoting physical activity among adolescent and young adult childhood cancer survivors: a pilot study. Pediatr Blood Cancer. 2017;64(12). https://doi.org/10.1002/pbc.26660.

  26. Krebs-Smith SM, Pannucci TE, Subar AF, Kirkpatrick SI, Lerman JL, Tooze JA, et al. Update of the healthy eating index: HEI-2015. J Acad Nutr Diet. 2018;118(9):1591–602.

    PubMed  PubMed Central  Google Scholar 

  27. Choi L, Liu Z, Matthews CE, Buchowski MS. Validation of accelerometer wear and nonwear time classification algorithm. Med Sci Sports Exerc. 2011;43(2):357–64.

    PubMed  PubMed Central  Google Scholar 

  28. Troiano RP, Berrigan D, Dodd KW, Masse LC, Tilert T, McDowell M. Physical activity in the United States measured by accelerometer. Med Sci Sports Exerc. 2008;40(1):181–8.

    PubMed  Google Scholar 

  29. Ayala GX, Elder JP. Qualitative methods to ensure acceptability of behavioral and social interventions to the target population. J Public Health Dent. 2011;71(Suppl 1):S69–79.

    PubMed  PubMed Central  Google Scholar 

  30. Krueger R. Developing questions for focus groups: focus group kit #3. Thousand Oaks: Sage Publications; 1998.

    Google Scholar 

  31. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.

    Google Scholar 

  32. Centers for Disease Control and Prevention. Physical activity for everyone. http://www.cdc.gov/physicalactivity/everyone/guidelines/index.html. Accessed 1 July 2020.

  33. Czajkowski SM, Powell LH, Adler N, Naar-King S, Reynolds KD, Hunter CM, et al. From ideas to efficacy: the ORBIT model for developing behavioral treatments for chronic diseases. Health Psychol. 2015;34(10):971–82.

    PubMed  PubMed Central  Google Scholar 

  34. Chow EJ, Mueller BA, Baker KS, Cushing-Haugen KL, Flowers ME, Martin PJ, et al. Cardiovascular hospitalizations and mortality among recipients of hematopoietic stem cell transplantation. Ann Intern Med. 2011;155(1):21–32.

    PubMed  Google Scholar 

  35. Armenian SH, Sun CL, Vase T, Ness KK, Blum E, Francisco L, et al. Cardiovascular risk factors in hematopoietic cell transplantation survivors: role in development of subsequent cardiovascular disease. Blood. 2012;120(23):4505–12.

    CAS  PubMed  PubMed Central  Google Scholar 

  36. van Nimwegen FA, Schaapveld M, Janus CP, Krol AD, Petersen EJ, Raemaekers JM, et al. Cardiovascular disease after Hodgkin lymphoma treatment: 40-year disease risk. JAMA Intern Med. 2015;175(6):1007–17.

    PubMed  Google Scholar 

  37. Patnode CD, Evans CV, Senger CA, Redmond N, Lin JS. Behavioral counseling to promote a healthful diet and physical activity for cardiovascular disease prevention in adults without known cardiovascular disease risk factors: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2017;318(2):175–93.

    PubMed  Google Scholar 

  38. LeFevre ML. Force USPST. Behavioral counseling to promote a healthful diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;161(8):587–93.

    PubMed  Google Scholar 

  39. Turner RR, Steed L, Quirk H, Greasley RU, Saxton JM, Taylor SJ, et al. Interventions for promoting habitual exercise in people living with and beyond cancer. Cochrane Database Syst Rev. 2018;9:CD010192. https://doi.org/10.1002/14651858.CD010192.pub3.

    Article  PubMed  Google Scholar 

  40. Burden S, Jones DJ, Sremanakova J, Sowerbutts AM, Lal S, Pilling M, et al. Dietary interventions for adult cancer survivors. Cochrane Database Syst Rev. 2019;2019(11). https://doi.org/10.1002/14651858.CD011287.pub2.

  41. Demark-Wahnefried W, Morey MC, Sloane R, Snyder DC, Miller PE, Hartman TJ, et al. Reach out to enhance wellness home-based diet-exercise intervention promotes reproducible and sustainable long-term improvements in health behaviors, body weight, and physical functioning in older, overweight/obese cancer survivors. J Clin Oncol. 2012;30(19):2354–61.

    PubMed  PubMed Central  Google Scholar 

  42. Courneya KS, Vardy JL, O'Callaghan CJ, Friedenreich CM, Campbell KL, Prapavessis H, et al. Effects of a structured exercise program on physical activity and fitness in colon cancer survivors: one year feasibility results from the CHALLENGE trial. Cancer Epidemiol Biomark Prev. 2016;25(6):969–77.

    Google Scholar 

  43. Perrin A, Turner E. Smartphones help blacks, Hispanics bridge some - but not all - digital gaps with whites. Pew Research Center https://www.pewresearch.org/fact-tank/2019/08/20/smartphones-help-blacks-hispanics-bridge-some-but-not-all-digital-gaps-with-whites/. Accessed 1 July 2020.

  44. Direito A, Carraca E, Rawstorn J, Whittaker R, Maddison R. mHealth technologies to influence physical activity and sedentary behaviors: behavior change techniques, systematic review and meta-analysis of randomized controlled trials. Ann Behav Med. 2017;51(2):226–39.

    PubMed  Google Scholar 

  45. Haberlin C, O'Dwyer T, Mockler D, Moran J, O’Donnell DM, Broderick J. The use of eHealth to promote physical activity in cancer survivors: a systematic review. Support Care Cancer. 2018;26(10):3323–36.

    PubMed  Google Scholar 

  46. Wong JN, McAuley E, Trinh L. Physical activity programming and counseling preferences among cancer survivors: a systematic review. Int J Behav Nutr Phys Act. 2018;15(1):48.

    PubMed  PubMed Central  Google Scholar 

  47. Vargas AJ, Schully SD, Villani J, Ganoza Caballero L, Murray DM. Assessment of prevention research measuring leading risk factors and causes of mortality and disability supported by the US National Institutes of Health. JAMA Netw Open. 2019;2(11):e1914718.

    PubMed  PubMed Central  Google Scholar 

  48. McNulty J, Kim W, Thurston T, Kim J, Larkey L. Interventions to improve quality of life, well-being, and care in Latino cancer survivors: a systematic literature review. Oncol Nurs Forum. 2016;43(3):374–84.

    PubMed  Google Scholar 

  49. Amireault S, Fong AJ, Sabiston CM. Promoting healthy eating and physical activity behaviors: a systematic review of multiple health behavior change interventions among cancer survivors. Am J Lifestyle Med. 2018;12(3):184–99.

    PubMed  Google Scholar 

  50. US Preventive Services Task Force, Grossman DC, Bibbins-Domingo K, Curry SJ, Barry MJ, Davidson KW, et al. Behavioral counseling to promote a healthful diet and physical activity for cardiovascular disease prevention in adults without cardiovascular risk factors: US Preventive Services Task Force recommendation statement. JAMA. 2017;318(2):167–74.

    Google Scholar 

  51. Tollosa DN, Tavener M, Hure A, James EL. Adherence to multiple health behaviours in cancer survivors: a systematic review and meta-analysis. J Cancer Surviv. 2019;13(3):327–43.

    PubMed  Google Scholar 

  52. Ligibel JA, Jones LW, Brewster AM, Clinton SK, Korde LA, Oeffinger KC, et al. Oncologists’ attitudes and practice of addressing diet, physical activity, and weight management with patients with cancer: findings of an ASCO survey of the oncology workforce. J Oncol Pract. 2019;15(6):e520–e8.

    PubMed  PubMed Central  Google Scholar 

Download references

Funding

Funding was provided in part by P30 CA015704, R01 CA204378, and R01 CA215134 from the US National Institutes of Health, and in part by FHCRC philanthropic funds.

Author information

Authors and Affiliations

  1. Fred Hutchinson Cancer Research Center, PO Box 19024, Mailstop M4-C308, Seattle, WA, 98109, USA

    Eric J. Chow, David R. Doody, Chongzhi Di, K. Scott Baker, Jonathan B. Bricker, Ajay K. Gopal, Anna M. Hagen, Stephanie J. Lee, Kerryn W. Reding, Jeannette M. Schenk, Karen L. Syrjala, Sarah A. Taylor, Guangxing Wang, Marian L. Neuhouser & Jason A. Mendoza

  2. Department of Pediatrics, University of Washington, Seattle, WA, USA

    Eric J. Chow, K. Scott Baker, Tyler G. Ketterl & Jason A. Mendoza

  3. City of Hope Medical Center, Duarte, CA, USA

    Saro H. Armenian

  4. Department of Medicine, University of Washington, Seattle, WA, USA

    Ajay K. Gopal & Stephanie J. Lee

  5. School of Nursing, University of Washington, Seattle, WA, USA

    Kerryn W. Reding

Authors
  1. Eric J. Chow
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David R. Doody
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chongzhi Di
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Saro H. Armenian
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. K. Scott Baker
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jonathan B. Bricker
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ajay K. Gopal
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Anna M. Hagen
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Tyler G. Ketterl
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Stephanie J. Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Kerryn W. Reding
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Jeannette M. Schenk
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Karen L. Syrjala
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Sarah A. Taylor
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Guangxing Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Marian L. Neuhouser
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Jason A. Mendoza
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study conception and design: EJC, CD, SHA, KSB, JBB, KWR, JMS, KLS, MLN, and JAM; patient selection: AKG and SJL; data collection: EJC, AMH, and SAT; data analysis: EJC, DRD, CD, and GW; initial manuscript draft: EJC and DRD; critical review and revision: all authors.

Corresponding author

Correspondence to Eric J. Chow.

Ethics declarations

The authors report no relevant disclosures. All participants provided informed consent, and the protocol and procedures were approved by FHCRC’s institutional review board (file number 10037).

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOC 34 kb).

ESM 2

(DOCX 14 kb).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chow, E.J., Doody, D.R., Di, C. et al. Feasibility of a behavioral intervention using mobile health applications to reduce cardiovascular risk factors in cancer survivors: a pilot randomized controlled trial. J Cancer Surviv 15, 554–563 (2021). https://doi.org/10.1007/s11764-020-00949-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11764-020-00949-w

Keywords

Search

Navigation