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Prescribing fitness apps for people with cancer: a preliminary assessment of content and quality of commercially available apps

Journal of Cancer Survivorship volume 13, pages 397–405 (2019)Cite this article

Abstract

Purpose

The benefits of physical activity for cancer survivors are increasingly recognised and smartphone applications are available to assist them to become more physically active. Cancer clinicians, however, lack confidence about which physical activity apps to recommend as evidence on their quality and content is limited. Therefore, we reviewed freely available commercial physical activity/fitness apps to systematically assess their behavioural change content and quality of their design.

Methods

Systematic searches of the app stores for Apple and Android operating systems were conducted and apps were screened to identify free apps appropriate for cancer survivors. Quality was assessed using the Mobile App Rating Scale (MARS) and behavioural content was evaluated using the Behavioural Change Techniques Taxonomy (BCTT).

Results

Of 341 apps identified, 67 were judged appropriate for cancer survivors and 46% combined aerobic and strength/stretching content. The overall number of behavioural change techniques (BCT) included was 3.96 (SD = 2.09), with the most frequent being ‘feedback on behaviour’ and ‘goal setting behaviour’. The mean scores for objective and subjective quality were 4.11 (SD = 0.59) and 3.07 (SD = 0.91) respectively (range 0 to 5). Finally, a modest positive correlation was found between the number of BCT and the quality of engagement, awareness and knowledge as assessed by the MARS.

Conclusion

Only a fifth of retrieved physical activity apps contained potentially suitable content for people affected by cancer. Overall, most apps we reviewed appeared to perform well in terms of their objective quality, but less well at promoting knowledge and awareness or help seeking related to physical activity.

Implications for Cancer Survivors

Many physical activity apps are available but the combined use of MARS and BCTT suggests that not all of them are suitable to the needs is a promising and feasible approach for assessing the applicability, usability and content of physical activity of apps employed by cancer survivors and this study is a first step toward developing a guide.

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References

  1. National Health Service. Physical activity guideline for adults. United Kingdom: National Health Service; 2015. Available at https://www.nhs.uk/live-well/exercise/. Accessed 12 Dec 2018.

  2. Javaheri PA, Nekolaichuk C, Haennel R, Parliament MB, McNeely ML. Feasibility of a pedometer-based walking program for survivors of breast and head and neck cancer undergoing radiation therapy. Physiother Can. 2015;67(2):205–13. https://doi.org/10.3138/ptc.2014-24O.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Courneya KS, Friedenreich CM. Physical activity and cancer: an introduction. Recent Results Cancer Res. 2011;186:1–10. https://doi.org/10.1007/978-3-642-04231-7_1.

    Article  PubMed  Google Scholar 

  4. Khan NF, Mant D, Carpenter L, Forman D, Rose PW. Long-term health outcomes in a British cohort of breast, colorectal and prostate cancer survivors: a database study. Br J Cancer. 2011;105(S1):S29–37. https://doi.org/10.1038/bjc.2011.420.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Van Blarigan EL, Meyerhardt JA. Role of physical activity and diet after colorectal cancer diagnosis. J Clin Oncol. 2015;33(16):1825–34. https://doi.org/10.1200/JCO.2014.59.7799.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Van Zutphen M, Winkels RM, van Duijnhoven FJ, van Harten-Gerritsen SA, Kok DE, van Duijvendijk P, et al. An increase in physical activity after colorectal cancer surgery is associated with improved recovery of physical functioning: a prospective cohort study. BMC Cancer. 2017;17(1):74. https://doi.org/10.1186/s12885-017-3066-2.

    Article  PubMed  PubMed Central  Google Scholar 

  7. 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. https://doi.org/10.3322/caac.21142.

    Article  PubMed  Google Scholar 

  8. Jorgensen ML, Young JM, Solomon MJ. Optimal delivery of colorectal cancer follow-up care: improving patient outcomes. Patient Relat Outcome Meas. 2015;6:127–38. https://doi.org/10.2147/PROM.S49589.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Husebø AM, Dyrstad SM, Søreide JA, Bru E. Predicting exercise adherence in cancer patients and survivors: a systematic review and meta-analysis of motivational and behavioural factors. J Clin Nurs. 2013;22(1–2):4–21. https://doi.org/10.1111/j.1365-2702.2012.04322.x.

    Article  PubMed  Google Scholar 

  10. Turner RR, Steed L, Quirk H, Greasley RU, Saxton JM, Taylor SJ, et al. Interventions for promoting habitual exercise in people living with and beyond cancer. Cochrane Database Syst Rev. 2018;(9):CD010192. https://doi.org/10.1002/14651858.CD010192.pub3.

  11. Bourke L, Homer KE, Thaha MA, Steed L, Rosario DJ, Robb KA, et al. Interventions to improve exercise behaviour in sedentary people living with and beyond cancer: a systematic review. Br J Cancer. 2014;110(4):831–41. https://doi.org/10.1038/bjc.2013.750.

    Article  CAS  PubMed  Google Scholar 

  12. Lowe SS, Watanabe SM, Baracos VE, Courneya KS. Physical activity interests and preferences in palliative cancer patients. Support Care Cancer. 2010;18(11):1469–75. https://doi.org/10.1007/s00520-009-0770-8.

    Article  PubMed  Google Scholar 

  13. Tsianakas V, Harris J, Ream E, Van Hemelrijck M, Purushotham A, Mucci L, et al. CanWalk: a feasibility study with embedded randomised controlled trial pilot of a walking intervention for people with recurrent or metastatic cancer. BMJ Open. 2017;7(2):e013719. https://doi.org/10.1136/bmjopen-2016-013719.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Deloitte. Global mobile consumer trends: second edition. London: Deloitte Touche Tohmatsu Limited; 2017. Available at https://www2.deloitte.com/global/en/pages/technology-media-and-telecommunications/articles/gx-global-mobile-consumer-trends.html. Accessed December 12, 2018

    Google Scholar 

  15. Turner-McGrievy GM, Hales SB, Schoffman DE, Valafar H, Brazendale K, Weaver RG, et al. Choosing between responsive-design websites versus mobile apps for your mobile behavioral intervention: presenting four case studies. Transl Behav Med. 2017;7(2):224–32. https://doi.org/10.1007/s13142-016-0448-y.

    Article  PubMed  Google Scholar 

  16. Harris J, Cheevers K, Armes J. The emerging role of digital health in monitoring and supporting people living with cancer and the consequences of its treatments. Curr Opin Support Palliat Care. 2018;12(3):268–75. https://doi.org/10.1097/SPC.0000000000000362.

    Article  PubMed  Google Scholar 

  17. Yang CH, Maher JP, Conroy DE. Implementation of behavior change techniques in mobile applications for physical activity. Am J Prev Med. 2015;48(4):452–5. https://doi.org/10.1016/j.amepre.2014.10.010.

    Article  PubMed  Google Scholar 

  18. Middelweerd A, Mollee JS, van der Wal CN, Brug J, Te Velde SJ. Apps to promote physical activity among adults: a review and content analysis. Int J Behav Nutr Phys Act. 2014;11(1):97. https://doi.org/10.1186/s12966-014-0097-9.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Short CE, Finlay A, Sanders I, Maher C. Development and pilot evaluation of a clinic-based mHealth app referral service to support adult cancer survivors increase their participation in physical activity using publicly available mobile apps. BMC Health Serv Res. 2018;18(1):27. https://doi.org/10.1186/s12913-017-2818-7.

    Article  PubMed  PubMed Central  Google Scholar 

  20. IJsbrandy C, Ottevanger PB, Tsekou Diogeni M, Gerritsen WR, van Harten WH, Hermens RPMG. Review: effectiveness of implementation strategies to increase physical activity uptake during and after cancer treatment. Crit Rev Oncol Hematol. 2018;122:157–63. https://doi.org/10.1016/j.critrevonc.2017.09.005.

    Article  CAS  PubMed  Google Scholar 

  21. Boudreaux ED, Waring ME, Hayes RB, Sadasivam RS, Mullen S, Pagoto S. Evaluating and selecting mobile health apps: strategies for healthcare providers and healthcare organizations. Transl Behav Med. 2014;4(4):363–71. https://doi.org/10.1007/s13142-014-0293-9.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Schoeppe S, Alley S, Rebar AL, Hayman M, Bray NA, Van Lippevelde W, et al. Apps to improve diet, physical activity and sedentary behaviour in children and adolescents: a review of quality, features and behaviour change techniques. Int J Behav Nutr Phys Act. 2017;14(1):83. https://doi.org/10.1186/s12966-017-0538-3.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Health Improvement Directorate. General practise physical activity questionnaire. London: National Health Service; 2009. Available at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/192453/GPPAQ_-_guidance.pdf. Accessed 12 Dec 2018

    Google Scholar 

  24. Stoyanov SR, Hides L, Kavanagh DJ, Zelenko O, Tjondronegoro D, Mani M. Mobile app rating scale: a new tool for assessing the quality of health mobile apps. JMIR Mhealth Uhealth. 2015;3(1):e27. https://doi.org/10.2196/mhealth.3422.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W, et al. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med. 2013;46(1):81–95. https://doi.org/10.1007/s12160-013-9486-6.

    Article  PubMed  Google Scholar 

  26. Michie S, Wood CE, Johnston M, Abraham C, Francis JJ, Hardeman W. Behaviour change techniques: the development and evaluation of a taxonomic method for reporting and describing behaviour change interventions (a suite of five studies involving consensus methods, randomised controlled trials and analysis of qualitative data). Health Technol Assess. 2015;19(99):1–188. https://doi.org/10.3310/hta19990.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Nyman SR, Adamczewska N, Howlett N. Systematic review of behaviour change techniques to promote participation in physical activity among people with dementia. Br J Health Psychol. 2018;23(1):148–70. https://doi.org/10.1111/bjhp.12279.

    Article  PubMed  Google Scholar 

  28. Pears S, Morton K, Bijker M, Sutton S, Hardeman W, Programme Team VBI. Development and feasibility study of very brief interventions for physical activity in primary care. BMC Public Health. 2015;15:333. https://doi.org/10.1186/s12889-015-1703-8.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Samdal GB, Eide GE, Barth T, Williams G, Meland E. Effective behaviour change techniques for physical activity and healthy eating in overweight and obese adults; systematic review and meta-regression analyses. Int J Behav Nutr Phys Act. 2017;14(1):42. https://doi.org/10.1186/s12966-017-0494-y.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Roberts AL, Fisher A, Smith L, Heinrich M, Potts HWW. Digital health behaviour change interventions targeting physical activity and diet in cancer survivors: a systematic review and meta-analysis. J Cancer Surviv. 2017;11(6):704–19. https://doi.org/10.1007/s11764-017-0632-1.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Siegel E. Fake reviews in Google Play and Apple App Store. Washington: Apptentive; 2014. https://www.apptentive.com/blog/2014/05/27/fake-reviews-google-play-apple-app-store/. Accessed 12 Dec 2018

    Google Scholar 

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Authors and Affiliations

  1. Facultad de Medicina y Ciencias de la Salud, Universidad de Oviedo, Oviedo, Spain

    R. Martín Payo

  2. School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK

    J. Harris & J. Armes

Authors
  1. R. Martín Payo
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  2. J. Harris
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  3. J. Armes
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Correspondence to R. Martín Payo.

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Martín Payo, R., Harris, J. & Armes, J. Prescribing fitness apps for people with cancer: a preliminary assessment of content and quality of commercially available apps. J Cancer Surviv 13, 397–405 (2019). https://doi.org/10.1007/s11764-019-00760-2

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Keywords

  • Physical activity
  • Colorectal neoplasms
  • Mobile applications
  • Telemedicine