JMIR Publications

ABSTRACT

Background:

Background:

Older cancer survivors are at risk for the development or worsening of both age- and treatment-related morbidity such as cardiovascular disease, diabetes, and physical function impairment. Sedentary behavior increases the risk for or exacerbates these chronic conditions. Light-intensity physical activity (LPA) is more common in older adults and individuals with moderate-severe comorbidities, and is associated with better physical health and psychosocial well-being. Thus, replacing sedentary time with LPA may provide a more successful strategy to both reduce sedentary time and increase physical activity.

Objective:

Objective:

The primary objective is to evaluate the feasibility, acceptability, and preliminary efficacy of a home-based mHealth intervention to interrupt and replace sedentary time with light physical activity (standing and stepping). The secondary objective is to examine changes in objective measures of physical activity and physical performance, and self-reported quality of life.

Methods:

Methods:

Fifty-four cancer survivors (60-84 years) were randomized in a 1:1:1 allocation to the Tech Support intervention group, Tech Support plus Health Coaching intervention group, or waitlist control. Intervention participants received a Jawbone UP2 activity monitor to use with their smart phone app for 13 weeks. Tech support and health coaching were provided via 5 telephone calls during the 13-week intervention. Sedentary behavior and physical activity were objectively measured using an activPAL monitor for 7 days pre- and post-intervention.

Results:

Results:

Participants included survivors of breast (39%), prostate (30%), and a variety of other cancer types who were 4.4±1.6 years since cancer diagnosis. Participants, on average, were 70 years old (SD=4.8), 55% female, 25% Hispanic, and 81% overweight or obese. Malfunction of the Jawbone trackers occurred in one-third of the intervention group, resulting in enrollment stopping at 54 rather than the initial goal of 60 participants. Despite these technical issues, retention in the intervention was high (87% retained). Adherence was high for wearing the tracker (100%) and checking the app daily (82%), but low for specific aspects related to the sedentary features of the tracker and app (21%-25%). Acceptability of the intervention was moderately high (78% overall). There were no significant between-group differences in total sedentary time, number of breaks, or number of prolonged sedentary bouts. Nor were there significant between-group differences in physical activity. The only significant within group change occurred within the health coaching group, which increased by 1675 daily steps (95% CI 444 to 2906, p=0.009). This increase was due to moderate, rather than light-intensity stepping (+15.2 minutes/day, 95% CI 4.1 to 26.2, p=0.008).

Conclusions:

Conclusions:

A home-based mHealth program to disrupt and replace sedentary time with stepping was feasible in and acceptable to older cancer survivors. Future studies are needed to evaluate the optimal approach for replacing sedentary behavior with standing and/or physical activity in this population. Clinical Trial: ClinicalTrials.gov NCT03632694 (https://clinicaltrials.gov/ct2/show/NCT03632694)