Determine the feasibility of a remotely delivered mobile health (mHealth)-supported intervention to improve diet and physical activity in hematologic malignancy survivors.
Pilot randomized controlled trial of a 16-week intervention for improving diet and physical activity: individualized goal-setting (daily steps, sodium, saturated fat, added sugar intake) per feedback from mHealth trackers (Fitbit for activity; Healthwatch360 for diet), supplemented by a Facebook peer support group. Controls accessed the trackers without goal-setting or peer support. Everyone received standardized survivorship counseling with tailored advice from a clinician. Actigraphy and food frequency questionnaires assessed activity and diet at baseline and follow-up.
Forty-one participants (51.2% male; median age 45.1 years; 7.0 years from treatment) were randomized (24 intervention; 17 control). Fitbit and Healthwatch360 use were more common among intervention versus control participants (75.0% versus 70.6% and 50.0% versus 17.7% of eligible days, respectively). Most intervention participants (66.7%) engaged with Facebook; overall, 91.7% interacted with the study’s mHealth applications. While no comparisons in activity or dietary outcomes between intervention versus control group met statistical significance, the intervention was associated with greater reductions in the targeted dietary factors and improvements in Healthy Eating Index-2015 score, moderate-vigorous physical activity time, and daily steps. Participant retention at 6 months was 90.2%.
An intervention for cardiovascular risk reduction based on individualized goal-setting enhanced by mHealth and social media peer support was feasible and acceptable among cancer survivors.
Implications for Cancer Survivors
Effective and easily disseminated strategies that improve diet and physical activity in this population are needed.
Registered in ClinicalTrials.gov (NCT03574012) on June 29, 2018.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Hull MC, Morris CG, Pepine CJ, Mendenhall NP. Valvular dysfunction and carotid, subclavian, and coronary artery disease in survivors of Hodgkin lymphoma treated with radiation therapy. JAMA. 2003;290(21):2831–7.
Baker KS, Ness KK, Steinberger J, Carter A, Francisco L, Burns LJ, et al. Diabetes, hypertension, and cardiovascular events in survivors of hematopoietic cell transplantation: a report from the bone marrow transplantation survivor study. Blood. 2007;109(4):1765–72.
Tichelli A, Bhatia S, Socie G. Cardiac and cardiovascular consequences after haematopoietic stem cell transplantation. Br J Haematol. 2008;142(1):11–26.
Chow EJ, Baker KS, Lee SJ, Flowers ME, Cushing-Haugen KL, Inamoto Y, et al. Influence of conventional cardiovascular risk factors and lifestyle characteristics on cardiovascular disease after hematopoietic cell transplantation. J Clin Oncol. 2014;32(3):191–8.
Leger KJ, Baker KS, Cushing-Haugen KL, Flowers MED, Leisenring WM, Martin PJ, et al. Lifestyle factors and subsequent ischemic heart disease risk after hematopoietic cell transplantation. Cancer. 2018;124(7):1507–15.
Schoeppe S, Alley S, Van Lippevelde W, Bray NA, Williams SL, Duncan MJ, et al. Efficacy of interventions that use apps to improve diet, physical activity and sedentary behaviour: a systematic review. Int J Behav Nutr Phys Act. 2016;13(1):127.
Balatsoukas P, Kennedy CM, Buchan I, Powell J, Ainsworth J. The role of social network technologies in online health promotion: a narrative review of theoretical and empirical factors influencing intervention effectiveness. J Med Internet Res. 2015;17(6):e141.
Teixeira PJ, Carraca EV, Markland D, Silva MN, Ryan RM. Exercise, physical activity, and self-determination theory: a systematic review. Int J Behav Nutr Phys Act. 2012;9:78.
Teixeira PJ, Carraca EV, Marques MM, Rutter H, Oppert JM, De Bourdeaudhuij I, et al. Successful behavior change in obesity interventions in adults: a systematic review of self-regulation mediators. BMC Med. 2015;13:84.
Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24(1):67–74.
Godin G, Jobin J, Bouillon J. Assessment of leisure time exercise behavior by self-report: a concurrent validity study. Can J Public Health. 1986;77(5):359–62.
Centers for Disease Control and Prevention. Behavioral risk factor surveillance system. http://www.cdc.gov/brfss/. Accessed 1 July 2020.
Schwarzer R, Luszczynska A. Self-efficacy. http://cancercontrol.cancer.gov/brp/research/constructs/self_efficacy.html. Accessed 1 July 2020.
Markland D, Tobin V. A modification to the behavioural regulation in exercise questionnaire to include an assessment of amotivation. J Sport Exerc Psychol. 2004;26(2):191–6.
Hearty AP, McCarthy SN, Kearney JM, Gibney MJ. Relationship between attitudes towards healthy eating and dietary behaviour, lifestyle and demographic factors in a representative sample of Irish adults. Appetite. 2007;48(1):1–11.
Patterson RE, Kristal AR, Tinker LF, Carter RA, Bolton MP, Agurs-Collins T. Measurement characteristics of the Women’s Health Initiative food frequency questionnaire. Ann Epidemiol. 1999;9(3):178–87.
Trost SG, McIver KL, Pate RR. Conducting accelerometer-based activity assessments in field-based research. Med Sci Sports Exerc. 2005;37(11 Suppl):S531–43.
Sasaki JE, John D, Freedson PS. Validation and comparison of ActiGraph activity monitors. J Sci Med Sport. 2011;14(5):411–6.
Committee on Cancer Survivorship. Improving Care and Quality of Life, National Cancer Policy Board. From cancer patient to cancer survivor: lost in transition. In: Hewitt M, Greenfield S, Stovall E, editors. . Washington, D.C: Institute of Medicine and National Research Council, National Academies Press; 2006.
Schulman-Green D, Bradley EH, Knobf MT, Prigerson H, DiGiovanna MP, McCorkle R. Self-management and transitions in women with advanced breast cancer. J Pain Symptom Manag. 2011;42(4):517–25.
Bricker JB, Watson NL, Mull KE, Sullivan BM, Heffner JL. Efficacy of smartphone applications for smoking cessation: a randomized clinical trial. JAMA Intern Med. 2020. https://doi.org/10.1001/jamainternmed.2020.4055.
O'Connor M, Whelan R, Bricker J, McHugh L. Randomized controlled trial of a smartphone application as an adjunct to acceptance and commitment therapy for smoking cessation. Behav Ther. 2020;51(1):162–77.
Van Horn L, Carson JA, Appel LJ, Burke LE, Economos C, Karmally W, et al. Recommended dietary pattern to achieve adherence to the American Heart Association/American College of Cardiology (AHA/ACC) guidelines: a scientific statement from the American Heart Association. Circulation. 2016;134(22):e505–e29.
Miropolsky EM, Baker KS, Abbey-Lambertz M, Syrjala K, Chow EJ, Ceballos R, et al. Participant perceptions on a Fitbit and Facebook intervention for young adult cancer survivors: a qualitative study. J Adolesc Young Adult Oncol. 2020;9(3):410–7.
Mendoza JA, Baker KS, Moreno MA, Whitlock K, Abbey-Lambertz M, Waite A, et al. A Fitbit and Facebook mHealth intervention for promoting physical activity among adolescent and young adult childhood cancer survivors: a pilot study. Pediatr Blood Cancer. 2017;64(12). https://doi.org/10.1002/pbc.26660.
Krebs-Smith SM, Pannucci TE, Subar AF, Kirkpatrick SI, Lerman JL, Tooze JA, et al. Update of the healthy eating index: HEI-2015. J Acad Nutr Diet. 2018;118(9):1591–602.
Choi L, Liu Z, Matthews CE, Buchowski MS. Validation of accelerometer wear and nonwear time classification algorithm. Med Sci Sports Exerc. 2011;43(2):357–64.
Troiano RP, Berrigan D, Dodd KW, Masse LC, Tilert T, McDowell M. Physical activity in the United States measured by accelerometer. Med Sci Sports Exerc. 2008;40(1):181–8.
Ayala GX, Elder JP. Qualitative methods to ensure acceptability of behavioral and social interventions to the target population. J Public Health Dent. 2011;71(Suppl 1):S69–79.
Krueger R. Developing questions for focus groups: focus group kit #3. Thousand Oaks: Sage Publications; 1998.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.
Centers for Disease Control and Prevention. Physical activity for everyone. http://www.cdc.gov/physicalactivity/everyone/guidelines/index.html. Accessed 1 July 2020.
Czajkowski SM, Powell LH, Adler N, Naar-King S, Reynolds KD, Hunter CM, et al. From ideas to efficacy: the ORBIT model for developing behavioral treatments for chronic diseases. Health Psychol. 2015;34(10):971–82.
Chow EJ, Mueller BA, Baker KS, Cushing-Haugen KL, Flowers ME, Martin PJ, et al. Cardiovascular hospitalizations and mortality among recipients of hematopoietic stem cell transplantation. Ann Intern Med. 2011;155(1):21–32.
Armenian SH, Sun CL, Vase T, Ness KK, Blum E, Francisco L, et al. Cardiovascular risk factors in hematopoietic cell transplantation survivors: role in development of subsequent cardiovascular disease. Blood. 2012;120(23):4505–12.
van Nimwegen FA, Schaapveld M, Janus CP, Krol AD, Petersen EJ, Raemaekers JM, et al. Cardiovascular disease after Hodgkin lymphoma treatment: 40-year disease risk. JAMA Intern Med. 2015;175(6):1007–17.
Patnode CD, Evans CV, Senger CA, Redmond N, Lin JS. Behavioral counseling to promote a healthful diet and physical activity for cardiovascular disease prevention in adults without known cardiovascular disease risk factors: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2017;318(2):175–93.
LeFevre ML. Force USPST. Behavioral counseling to promote a healthful diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;161(8):587–93.
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.
Burden S, Jones DJ, Sremanakova J, Sowerbutts AM, Lal S, Pilling M, et al. Dietary interventions for adult cancer survivors. Cochrane Database Syst Rev. 2019;2019(11). https://doi.org/10.1002/14651858.CD011287.pub2.
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.
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.
Perrin A, Turner E. Smartphones help blacks, Hispanics bridge some - but not all - digital gaps with whites. Pew Research Center https://www.pewresearch.org/fact-tank/2019/08/20/smartphones-help-blacks-hispanics-bridge-some-but-not-all-digital-gaps-with-whites/. Accessed 1 July 2020.
Direito A, Carraca E, Rawstorn J, Whittaker R, Maddison R. mHealth technologies to influence physical activity and sedentary behaviors: behavior change techniques, systematic review and meta-analysis of randomized controlled trials. Ann Behav Med. 2017;51(2):226–39.
Haberlin C, O'Dwyer T, Mockler D, Moran J, O’Donnell DM, Broderick J. The use of eHealth to promote physical activity in cancer survivors: a systematic review. Support Care Cancer. 2018;26(10):3323–36.
Wong JN, McAuley E, Trinh L. Physical activity programming and counseling preferences among cancer survivors: a systematic review. Int J Behav Nutr Phys Act. 2018;15(1):48.
Vargas AJ, Schully SD, Villani J, Ganoza Caballero L, Murray DM. Assessment of prevention research measuring leading risk factors and causes of mortality and disability supported by the US National Institutes of Health. JAMA Netw Open. 2019;2(11):e1914718.
McNulty J, Kim W, Thurston T, Kim J, Larkey L. Interventions to improve quality of life, well-being, and care in Latino cancer survivors: a systematic literature review. Oncol Nurs Forum. 2016;43(3):374–84.
Amireault S, Fong AJ, Sabiston CM. Promoting healthy eating and physical activity behaviors: a systematic review of multiple health behavior change interventions among cancer survivors. Am J Lifestyle Med. 2018;12(3):184–99.
US Preventive Services Task Force, Grossman DC, Bibbins-Domingo K, Curry SJ, Barry MJ, Davidson KW, et al. Behavioral counseling to promote a healthful diet and physical activity for cardiovascular disease prevention in adults without cardiovascular risk factors: US Preventive Services Task Force recommendation statement. JAMA. 2017;318(2):167–74.
Tollosa DN, Tavener M, Hure A, James EL. Adherence to multiple health behaviours in cancer survivors: a systematic review and meta-analysis. J Cancer Surviv. 2019;13(3):327–43.
Ligibel JA, Jones LW, Brewster AM, Clinton SK, Korde LA, Oeffinger KC, et al. Oncologists’ attitudes and practice of addressing diet, physical activity, and weight management with patients with cancer: findings of an ASCO survey of the oncology workforce. J Oncol Pract. 2019;15(6):e520–e8.
Funding was provided in part by P30 CA015704, R01 CA204378, and R01 CA215134 from the US National Institutes of Health, and in part by FHCRC philanthropic funds.
The authors report no relevant disclosures. All participants provided informed consent, and the protocol and procedures were approved by FHCRC’s institutional review board (file number 10037).
Conflict of interest
The authors declare that they have no conflict of interest.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Chow, E.J., Doody, D.R., Di, C. et al. Feasibility of a behavioral intervention using mobile health applications to reduce cardiovascular risk factors in cancer survivors: a pilot randomized controlled trial. J Cancer Surviv 15, 554–563 (2021). https://doi.org/10.1007/s11764-020-00949-w
- Cancer survivorship
- Cardiovascular disease
- Peer support
- Physical activity