Journal of Cancer Survivorship

, Volume 12, Issue 1, pp 82–94 | Cite as

SurvivorCHESS to increase physical activity in colon cancer survivors: can we get them moving?

  • Deborah K. MayerEmail author
  • Gina Landucci
  • Lola Awoyinka
  • Amy K. Atwood
  • Cindy L. Carmack
  • Wendy Demark-Wahnefried
  • Fiona McTavish
  • David H. Gustafson



This randomized controlled trial evaluated the impact of SurvivorCHESS, an eHealth intervention, on physical activity in colon cancer survivors and to explore the impact of SurvivorCHESS on quality of life and distress.


This was a two-arm single-blinded multi-site randomized controlled trial comparing a control group to an intervention group receiving a smartphone with the SurvivorCHESS program.


Participants using SurvivorCHESS (n = 144) increased their moderate to vigorous physical activities from 19.4 min at baseline to 50 min compared to the control group (n = 140) increasing from 15.5 to 40.3 min at 6 months (p = .083) but was not sustained 3 months after the study ended. No significant differences were found between groups over time for quality of life or distress items. Reports of physical symptoms were greater than other categories for distress items. Patients who had a higher body mass index and number of comorbid conditions were less likely to increase their physical activity. Self-determination theory including autonomous motivation and relatedness was not associated with the outcomes.


Physical activity did increase over time in both groups and was not significantly different with the use of the eHealth intervention, SurvivorCHESS, compared to the control group. The amount of SurvivorCHESS use was not associated with physical activity.

Implications for cancer survivors

Increasing physical activity in colon cancer survivors has the potential to improve quality of life and reduce recurrences. Using smartphone-tracking devices may be useful in helping to change this health behavior.


Colon cancer Physical activity Cancer survivorship Surveillance Survivorship care Plans eHealth 



We would like to thank all participants and staff involved in this study. We would also like to thank Ming-Yuan Chih, PhD, University of Kentucky, College of Health Sciences, for his assistance with additional statistical analyses. This paper is based on a presentation at the NCI Centers of Excellence in Cancer Communication Research (CECCR) 2013 Grantee Meeting, Ann Arbor, MI.

Funding information

This study was supported by a grant from the National Cancer Institute (P50 CA095817).

Compliance with ethical standards

This study was approved by the relevant institutional review boards at all the centers. Participants provided written informed consent before starting the study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institution.

Conflict of interest

Deborah K. Mayer, Stock Holder for CareVive. The other authors declare that they have no conflict of interest.


  1. 1.
    Ballard-Barbash R, Potosky AL, Harlan LC, Nayfield SG, Kessler LG. Factors associated with surgical and radiation therapy for early stage breast cancer in older women. J Natl Cancer Inst. 1996;88(11):716–26.CrossRefPubMedGoogle Scholar
  2. 2.
    Arem H, Pfeiffer RM, Engels EA, Alfano CM, Hollenbeck A, Park Y, et al. Pre- and postdiagnosis physical activity, television viewing, and mortality among patients with colorectal cancer in the National Institutes of Health-AARP diet and health study. J Clin Oncol. 2014.Google Scholar
  3. 3.
    Lemanne D, Cassileth B, Gubili J. The role of physical activity in cancer prevention, treatment, recovery, and survivorship. Oncology (Williston Park). 2013;27(6):580–5.Google Scholar
  4. 4.
    Winzer BM, Whiteman DC, Reeves MM, Paratz JD. Physical activity and cancer prevention: a systematic review of clinical trials. Cancer Causes Control. 2011;22(6):811.CrossRefPubMedGoogle Scholar
  5. 5.
    Gunnell AS, Joyce S, Tomlin S, Taaffe DR, Cormie P, Newton RU, et al. Physical activity and survival among long-term cancer survivor and non-cancer cohorts. Front Public Health. 2017;5:19.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Fong DY, Ho JW, Hui BP, Lee AM, Macfarlane DJ, Leung SS, et al. Physical activity for cancer survivors: meta-analysis of randomised controlled trials. BMJ. 2012;344:e70.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Wu W, Guo F, Ye J, Li Y, Shi D, Fang D, et al. Pre- and post-diagnosis physical activity is associated with survival benefits of colorectal cancer patients: a systematic review and meta-analysis. Oncotarget. 2016;7(32):52095–103.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Anzuini F, Battistella A, Izzotti A. Physical activity and cancer prevention: a review of current evidence and biological mechanisms. J Prev Med Hyg. 2011;52(4):174–80.PubMedGoogle Scholar
  9. 9.
    Ballard-Barbash R, Friedenreich CM, Courneya KS, Siddiqi SM, McTiernan A, Alfano CM. Physical activity, biomarkers, and disease outcomes in cancer survivors: a systematic review. J Natl Cancer Inst. 2012;104(11):815–40.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Meneses-Echavez JF, Gonzalez-Jimenez E, Ramirez-Velez R. Supervised exercise reduces cancer-related fatigue: a systematic review. J Physiother. 2014;12.Google Scholar
  11. 11.
    Rock CL, Doyle C, Demark-Wahnefried W, Meyerhardt J, Courneya KS, Schwartz AL, et al. Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin. 2012;62(4):243–74.CrossRefPubMedGoogle Scholar
  12. 12.
    Cell phone and smartphone ownership demographics [Internet]. Washington, DC: Pew Research Center; 2014 [cited 9/2/16]. Available from:
  13. 13.
    Mobile health 2012 [Internet]. Pew Research Internet Project [cited 12/26/14]. Available from:
  14. 14.
    Whitehead L, Seaton P. The effectiveness of self-management mobile phone and tablet apps in long-term condition management: a systematic review. J Med Internet Res. 2016;18(5):e97.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Zhao J, Freeman B, Li M. Can mobile phone apps influence people’s health behavior change? An evidence review. J Med Internet Res. 2016;18(11):e287.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Fanning J, Mullen SP, McAuley E. Increasing physical activity with mobile devices: a meta-analysis. J Med Internet Res. 2012;14(6):e161.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Gustafson DH, McTavish FM, Chih MY, Atwood AK, Johnson RA, Boyle MG, et al. A smartphone application to support recovery from alcoholism: a randomized clinical trial. JAMA Psychiatry. 2014;71(5):566–72.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Gustafson DH, Boyle MG, Shaw BR, Isham A, McTavish F, Richards S, et al. An e-health solution for people with alcohol problems. Alcohol Res Health. 2011;33(4):327–37.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Gustafson DH, DuBenske LL, Namkoong K, Hawkins R, Chih MY, Atwood AK, et al. An eHealth system supporting palliative care for patients with non-small cell lung cancer: a randomized trial. Cancer. 2013;119(9):1744–51.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    DuBenske LL, Wen KY, Gustafson DH, Guarnaccia CA, Cleary JF, Dinauer SK, et al. Caregivers’ differing needs across key experiences of the advanced cancer disease trajectory. Palliat Support Care. 2008;6(3):265–72.CrossRefPubMedGoogle Scholar
  21. 21.
    DuBenske LL, Gustafson DH, Namkoong K, Hawkins RP, Atwood AK, Brown RL, et al. CHESS improves cancer caregivers’ burden and mood: results of an eHealth RCT. Health Psychol. 2014;33(10):1261–72.CrossRefPubMedGoogle Scholar
  22. 22.
    Gustafson DH, Bosworth K, Hawkins RP, Boberg EW, Bricker E. CHESS: a computer-based system for providing information, referrals, decision support and social support to people facing medical and other health-related crises. Proc Annu Symp Comput Appl Med Care. 1992:161–5.Google Scholar
  23. 23.
    Chih MY, DuBenske LL, Hawkins RP, Brown RL, Dinauer SK, Cleary JF, et al. Communicating advanced cancer patients’ symptoms via the internet: a pooled analysis of two randomized trials examining caregiver preparedness, physical burden, and negative mood. Palliat Med. 2013;27(6):533–43.CrossRefPubMedGoogle Scholar
  24. 24.
    Deci E, Ryan R. Handbook of self-determination research. Rochester, NY: University of Rochester Press; 2002.Google Scholar
  25. 25.
    Gustafson D, Wise M, Bhattacharya A, Pulvermacher A, Shanovich K, Phillips B, et al. The effects of combining web-based eHealth with telephone nurse case management for pediatric asthma control: a randomized controlled trial. J Med Internet Res. 2012;14(4):e101.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Godin G, Shephard RJ. A simple method to assess exercise behavior in the community. Can J Appl Sport Sci. 1985;10(3):141–6.PubMedGoogle Scholar
  27. 27.
    Gionet NJ, Godin G. Self-reported exercise behavior of employees: a validity study. J Occup Med. 1989;31(12):969–73.CrossRefPubMedGoogle Scholar
  28. 28.
    Jacobs DR Jr, Ainsworth BE, Hartman TJ, Leon AS. A simultaneous evaluation of 10 commonly used physical activity questionnaires. Med Sci Sports Exerc. 1993;25(1):81–91.CrossRefPubMedGoogle Scholar
  29. 29.
    Amireault S, Godin G. The Godin-Shephard leisure-time physical activity questionnaire: validity evidence supporting its use for classifying healthy adults into active and insufficiently active categories. Percept Mot Skills. 2015;120(2):604–22.CrossRefPubMedGoogle Scholar
  30. 30.
    Amireault S, Godin G, Lacombe J, Sabiston CM. The use of the Godin-Shephard leisure-time physical activity questionnaire in oncology research: a systematic review. BMC Med Res Methodol. 2015;15:60. 015-0045-7 CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Godin G. The Godin-Shephard leisure-time exercise questionnaire. Health Fi J Can. 2011;4(1):18–22.Google Scholar
  32. 32.
    NCCN distress management [Internet]. National Comprehensive Cancer Network; 2016 [cited 4/2/17]. Available from:
  33. 33.
    Jacobsen PB, Donovan KA, Trask PC, Fleishman SB, Zabora J, Baker F, et al. Screening for psychologic distress in ambulatory cancer patients. Cancer. 2005;103(7):1494–502.CrossRefPubMedGoogle Scholar
  34. 34.
    Mitchell AJ. Pooled results from 38 analyses of the accuracy of distress thermometer and other ultra-short methods of detecting cancer-related mood disorders. J Clin Oncol. 2007;25(29):4670–81.CrossRefPubMedGoogle Scholar
  35. 35.
    Ward WL, Hahn EA, Mo F, Hernandez L, Tulsky DS, Cella D. Reliability and validity of the functional assessment of cancer therapy-colorectal (FACT-C) quality of life instrument. Qual Life Res. 1999;8(3):181–95.CrossRefPubMedGoogle Scholar
  36. 36.
    Gustafson DH, Hawkins R, McTavish F, Pingree S, Chen WC, Volrathongchai K, et al. Internet-based interactive support for cancer patients: are integrated systems better? Aust J Commun. 2008;58(2):238–57.CrossRefGoogle Scholar
  37. 37.
    Cohen J, Cohen P. Applied multiple regression/correlation analysis for the behavioral sciences. Hillsdale: Erlbaum; 1983.Google Scholar
  38. 38.
    Gustafson DH, Hawkins R, Pingree S, McTavish F, Arora NK, Mendenhall J, et al. Effect of computer support on younger women with breast cancer. J Gen Intern Med. 2001;16(7):435–45.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Japuntich SJ, Zehner ME, Smith SS, Jorenby DE, Valdez JA, Fiore MC, et al. Smoking cessation via the internet: a randomized clinical trial of an internet intervention as adjuvant treatment in a smoking cessation intervention. Nicotine Tob Res. 2006;8(Suppl 1):S59–67.CrossRefPubMedGoogle Scholar
  40. 40.
    Saver BG, Gustafson D, Taylor TR, Hawkins RP, Woods NF, Dinauer S, et al. A tale of two studies: the importance of setting, subjects and context in two randomized, controlled trials of a web-based decision support for perimenopausal and postmenopausal health decisions. Patient Educ Couns. 2007;66(2):211–22.CrossRefPubMedGoogle Scholar
  41. 41.
    Gustafson DH, Hawkins R, Boberg E, Pingree S, Serlin RE, Graziano F, et al. Impact of a patient-centered, computer-based health information/support system. Am J Prev Med. 1999;16(1):1–9.CrossRefPubMedGoogle Scholar
  42. 42.
    Vollmer Dahlke D, Fair K, Hong YA, Beaudoin CE, Pulczinski J, Ory MG. Apps seeking theories: results of a study on the use of health behavior change theories in cancer survivorship mobile apps. JMIR Mhealth Uhealth. 2015;3(1):e31.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Kuijpers W, Groen WG, Aaronson NK, van Harten WH. A systematic review of web-based interventions for patient empowerment and physical activity in chronic diseases: relevance for cancer survivors. J Med Internet Res. 2013;15(2):e37.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Morey MC, Blair CK, Sloane R, Cohen HJ, Snyder DC, Demark-Wahnefried W. Group trajectory analysis helps to identify older cancer survivors who benefit from distance-based lifestyle interventions. Cancer. 2015;121(24):4433–40.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Kenzik KM, Morey MC, Cohen HJ, Sloane R, Demark-Wahnefried W. Symptoms, weight loss, and physical function in a lifestyle intervention study of older cancer survivors. J Geriatr Oncol. 2015;6(6):424–32.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Demark-Wahnefried W, Clipp EC, Morey MC, Pieper CF, Sloane R, Snyder DC, et al. Lifestyle intervention development study to improve physical function in older adults with cancer: outcomes from project LEAD. J Clin Oncol. 2006;24(21):3465–73.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    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.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    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.CrossRefGoogle Scholar
  49. 49.
    Van Vulpen JK, Velthuis MJ, Steins Bisschop CN, Travier N, Van Den Buijs BJ, Backx FJ, et al. Effects of an exercise program in colon cancer patients undergoing chemotherapy. Med Sci Sports Exerc. 2016;48(5):767–75.CrossRefPubMedGoogle Scholar
  50. 50.
    Mobile fact sheet [Internet]. Pew Research Center Internet & Technology; 2017 [updated January 12, 2017; cited 8/5/17]. Available from:
  51. 51.
    Ernsting C, Dombrowski SU, Oedekoven M, O’Sullivan JL, Kanzler M, Kuhlmey A, et al. Using smartphones and health apps to change and manage health behaviors: a population-based survey. J Med Internet Res. 2017;19(4):e101.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Krebs P, Shtaynberger J, McCabe M, Iocolano M, Williams K, Shuk E, et al. An eHealth intervention to increase physical activity and healthy eating in older adult cancer survivors: summative evaluation results. JMIR Cancer. 2017;3(1):e4.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    SEER stat fact sheets: colon and rectum cancer [Internet]. Bethesda, MD: National Cancer Institute [cited 12/26/14]. Available from:
  54. 54.
    Van Blarigan EL, Meyerhardt JA. Role of physical activity and diet after colorectal cancer diagnosis. J Clin Oncol. 2015;33(16):1825–34.CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Winkels RM, Heine-Broring RC, van Zutphen M, van Harten-Gerritsen S, Kok DE, van Duijnhoven FJ, et al. The COLON study: colorectal cancer: longitudinal, observational study on nutritional and lifestyle factors that may influence colorectal tumour recurrence, survival and quality of life. BMC Cancer. 2014;14:374. 2407-14-374CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    Winkels RM, van Lee L, Beijer S, Bours MJ, van Duijnhoven FJ, Geelen A, et al. Adherence to the World Cancer Research Fund/American Institute for Cancer Research lifestyle recommendations in colorectal cancer survivors: results of the PROFILES registry. Cancer Med. 2016;14.Google Scholar
  57. 57.
    Nyrop KA, Deal AM, Williams GR, Guerard EJ, Pergolotti M, Muss HB. Physical activity communication between oncology providers and patients with early-stage breast, colon, or prostate cancer. Cancer. 2016;122(3):470–6.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Deborah K. Mayer
    • 1
    Email author
  • Gina Landucci
    • 2
  • Lola Awoyinka
    • 2
  • Amy K. Atwood
    • 3
  • Cindy L. Carmack
    • 4
  • Wendy Demark-Wahnefried
    • 5
  • Fiona McTavish
    • 2
  • David H. Gustafson
    • 2
  1. 1.UNC Lineberger Cancer CenterUniversity of North CarolinaChapel HillUSA
  2. 2.Center for Health Enhancement Systems StudiesUniversity of Wisconsin-MadisonMadisonUSA
  3. 3.T-Mobile Workforce Analysis and InsightsBellevueUSA
  4. 4.Department of Behavior ScienceM.D. Anderson Cancer CenterHoustonUSA
  5. 5.UAB Comprehensive Cancer CenterUniversity of AlabamaBirminghamUSA

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