Web-Based Tool Motivates Teen Cancer Survivors to Exercise

Roxanne Nelson, RN, BSN

February 14, 2018

A web-based, interactive intervention has proved successful in motivating preteen and adolescent survivors of pediatric cancer to stay physically active.

Findings from a new pilot study showed that participation in the web-based intervention increased their level of moderate to vigorous physical activity by an average of almost 5 minutes a week, while the control group decreased their activity by an average of over 24 minutes.

Survivors in the intervention group also showed improvements in fitness, neurocognitive, and quality-of-life measures.

The findings were presented at a press briefing held ahead of the upcoming Cancer Survivorship Symposium (CSS) Advancing Care and Research in Orlando, Florida.

"Increasing physical activity may have positive effects on fitness, cognition, and quality of life in adolescent survivors of pediatric cancer," said lead study author, Carrie R. Howell, PhD, a clinical research scientist at St. Jude Children's Research Hospital in Memphis, Tennessee. "By intervening in this young age group, we hope to help kids develop healthy exercise habits for life."

Many childhood cancer survivors, even those treated in the "modern" era of cancer care, where treatments are significantly less intense than those used in the past, continue to report poor general health.

One recent study reported that by age 50 years, nearly all survivors report twice as many severe health conditions as the general public. By mid-life, 96% of survivors had an average of 17 chronic health conditions.

"Survivors of childhood cancer at increased risk for obesity and metabolic syndrome," said Howell, but she emphasized that this could be remediated with regular physical activity.

She added that creative and engaging interventions that will motivate young cancer survivors are needed.

Unique Tool With Rewards

Howell and colleagues conducted a pilot study to evaluate the efficacy of a web-delivered, interactive, rewards-based physical activity intervention in increasing moderate to vigorous physical activity and its effect on fitness, neurocognitive, and health-related quality-of-life (HRQoL) outcomes during a 24-week period.

The cohort comprised 97 cancer survivors aged 11 to 15 years (mean age, 12.7 years) who had completed their cancer treatment at St. Jude and reported engaging in less than 60 minutes of exercise per day.

Participants were randomly assigned to the intervention or control group. Both study groups received an educational handout containing information about the importance of physical activity and examples of activities, as well as a wearable activity monitor. 

The intervention group was also given access to an interactive, age-appropriate website. Every week they would log their activity into the website, and if they reached certain activity goals, they would receive awards, including T-shirts and gift cards.

Physical activity, fitness, neurocognitive, and HRQoL outcomes were assessed at baseline and 24 weeks, and the main changes in outcomes were compared between groups by using paired t-tests.

Of the initial cohort, 78 participants completed the study: 53 in the intervention group and 25 in the control group.

The time spent participating in moderate-to-vigorous physical activity increased by an average of 4.7 minutes per week in the intervention group but declined by an average of 24.3 minutes per week in the control group.

In addition to the above-mentioned time spent being physically active, other measures also improved in the intervention group. For fitness, hand-grip strength improved from an average of 19.9 kg to 21.0 kg, the number of situps improved from an average of 11 to 14, and the number of pushups improved from an average of 15 to 18.

When looking at neurocognitive outcomes, the researchers noted that verbal fluency z-score increased by 0.13 points and general cognition z-score increased by 0.23 points in the intervention group.

Finally, for HRQoL the score for overall quality-of-life score increased from an average score of 74.2 to 78.0, and physical function–related quality-of-life score increased from an average score of 74.2 to 78.0.

None of these measures changed significantly in the control group.

Encouraged by the results of this pilot study, Howell explained that her team has designed a larger clinical trial of a web-based physical activity intervention. The trial, ALTE1631, hopes to enroll 384 survivors of childhood acute lymphoblastic leukemia  at multiple institutions and will run for 1 year, with a follow-up at 18 months. 

"This is more evidence of the many kinds of benefits that are derived from increasing physical activity," commented Timothy Gilligan, MD, MSc, presscast moderator and a medical oncologist at the Cleveland Clinic in Ohio. "This reminds us that we may need to be creative in how motivate and engage people."

"This is an interesting study of a new tool to do that, and generate evidence of efficacy," he added.

The study was supported by grants from the National Cancer Institute Cancer and by the American Lebanese Syrian Associated Charities; devices, website access, and study support were provided by HopeLab. Howell has no disclosures. Coauthor Melissa M. Hudson, MD, has disclosed a consulting or advisory role with Coleman Supportive Oncology Initiative for Children with Cancer, Oncology Research Information Exchange Network, Pfizer, and Princess Máxima Center. Gilligan has disclosed a relationship with Wellpoint.

Cancer Survivorship Symposium (CSS) Advancing Care and Research. Abstract 102 To be presented February 16, 2018.

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