JMIR Publications

ABSTRACT

Background:

Physical activity (PA) alleviates many treatment-related side effects in gynecologic cancer survivors, yet long-term PA levels remain low. Mobile health (mHealth) interventions can support self-management and increase PA levels; however, evidence from real-world, year-long engagement with smartphone applications (apps) in this population is still limited.

Objective:

To describe 12-month user engagement with the PA component of a smartphone app, implemented as part of routine nurse-led follow-up in a real-world cohort of gynecologic cancer survivors.

Methods:

This descriptive study analyzed server-generated log data from the intervention arm of the multicenter, quasi-experimental LETSGO trial (NCT04122235). Between December 2019 and July 2022, 378 cancer survivors (ovarian, endometrial, cervical, or vulvar/vaginal cancer) from five Norwegian hospitals received the app plus a Garmin Vivofit-4 activity tracker alongside standard consultations. Primary outcomes for the present study were (1) weekly PA registrations (objective step counts from activity tracker and self-reported PAs) and (2) temporal patterns of step logging during each cancer survivor’s first 52 weeks post-enrollment. Secondary analyses compared baseline characteristics of app users (≥ 2 weeks of PA logging) and non-users. Descriptive statistics were used to summarize baseline characteristics. Group comparisons were performed using independent t-tests for normally distributed continuous variables, Mann-Whitney U tests for non-normally distributed variables, and Pearson’s chi-square tests for categorical variables. Statistical significance was set at P<.05.

Results:

Of 378 eligible participants (mean age 63 ± 13 years; BMI 28.5 ± 6.4 kg/m²), 272 (72%) logged at least two weeks of PA, and 225 (60%) synchronized objective step data. Mean daily steps were 5,657 ± 2,799. Step tracking dominated use (21 ± 16 logged weeks), followed by self-reported walking (23 ± 19 weeks) and resistance training (15 ± 16 weeks). Weekly step-logger counts fell around study weeks 16, 32, and 44, but rebounded by 30–50 participants within three weeks, indicating episodic rather than permanent disengagement. App users were younger (mean difference = –6.7 y; P<.001), more often employed (χ²(2)=43.49; P<.001), and more likely to have higher education (χ²(3)=44.25; P<.001) than non-users. Tumor type and treatment modality were not associated with engagement.

Conclusions:

In a routine-care setting, nearly three-quarters of gynecologic cancer survivors engaged repeatedly with an app-supported PA module over 12 months, although mean PA levels were modest and participation was more prevalent among younger, employed, and higher-educated participants. Engagement followed an ebb-and-flow pattern, suggesting that built-in re-engagement prompts and equity-focused onboarding are needed to sustain and broaden participation. These findings support the feasibility of blended mHealth follow-up, while highlighting the importance of adaptive strategies to promote long-term PA adherence and bridge the digital divide among cancer survivors. Clinical Trial: ClinicalTrials.gov identifier: NCT04122235