JMIR Publications

ABSTRACT

Background:

Physical activity (PA) interventions can increase PA and improve well-being among adults affected by cancer, yet most do not meet cancer-specific PA recommendations. Lack of time, limited access to facilities, and travel distances are barriers to participating in PA interventions. Electronic health technologies (eHealth) may address some of these barriers and serve as a viable way to promote PA behavior change in this population. Nevertheless, no review has synthesized available evidence across eHealth and cancer types from July 2018 onward, nor examined the use of behavioral theory and behavior change techniques (BCTs) leaving important gaps in knowledge.

Objective:

To provide a comprehensive, updated overview of evidence on eHealth PA interventions for adults with cancer by (1) describing the current state of the literature, (2) exploring associations between intervention characteristics and effectiveness, (3) assessing the bias and completeness of evidence, and (4) identifying future research needs.

Methods:

Medline, Embase, CINAHL, SportDiscus, Scopus, and the Cochrane Central Register of Controlled Trials were searched for articles describing eHealth PA interventions for adults affected by cancer. Study selection and data extraction was performed in duplicate with consultation from the senior author. 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 associations between intervention characteristics and effectiveness.

Results:

Seventy-one articles (67 studies) involving 6655 participants (Mage=56.7±8.2 years) were included. Nearly 50% of included articles were published after July 2018. Significant post-intervention increases in PA levels were noted in 52% of studies and PA maintenance noted in 5 of the 12 studies that included a follow-up. Study duration, primary objectives, and eHealth modality (e.g. websites, activity trackers, text messaging) varied widely. Social cognitive theory (34%) was the most commonly used theory. The mean number of BCTs used across studies was 13.5±5.5 with self-monitoring, credible source, and goal-setting being used in over 90% of studies. Weight analyses showed 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 due to risk of confounding and measurement bias, and incomplete reporting.

Conclusions:

A range of eHealth PA interventions may increase PA levels among adults affected by cancer and specific intervention components (e.g. websites, use of theory, 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. Clinical Trial: PROSPERO: CRD42020162181.