The role of eHealth to promote physical activity in people with cancer.

Abstract

The role of eHealth to promote physical activity in people with cancer. Ciar?n Haberlin BSc (Physiotherapy), P.Grad. Cert (Clinical Exercise)

Background Exercise and physical activity (PA) are established and effective treatment options for various side effects of cancer treatments such as surgery, chemotherapy and radiotherapy. However, PA levels in cancer survivors remain low. The advent of eHealth brings new opportunities to influence healthy behaviours, using interactive and novel approaches. Influencing PA behaviours in people with cancer presents a potential application of this. The aim of this thesis was to explore and evaluate the feasibility and preliminary efficacy of an intervention, using eHealth, for increasing PA in cancer survivors.

Methods A systematic review, cross-sectional questionnaire-based study, qualitative focus group study and a single-arm pre?post feasibility study were conducted in this thesis. The systematic review that was conducted as part of this thesis investigated the current research in the use and effects of eHealth in the promotion of PA among cancer survivors. A questionnaire-based study was conducted to explore the role of technology and PA in the lives of people with cancer. This was designed to ascertain knowledge and current adherence to PA guidelines, as well as smartphone penetration in cancer survivors. Qualitative research, in the form of a series of focus groups, aimed to establish cancer survivor perceptions to using mobile technology for PA promotion. This included an exploration of barriers and facilitators to the use of mobile technology, as well as potential features of an optimal PA intervention from the perception of cancer survivors. Finally, a feasibility study was designed to evaluate the feasibility and preliminary efficacy of an intervention, using eHealth, for increasing PA in cancer survivors. This adopted the use of a Fitbit wearable tracker, and primarily evaluated a variety of feasibility outcomes such as acceptability and adherence of the intervention. Secondary outcomes included preliminary efficacy of the intervention in terms of outcomes such as PA (objective and self-report), body composition and quality of life.

Results Results from the systematic review showed the paucity of studies that examined the use of eHealth PA interventions in cancer survivors, with only 10 studies meeting eligibility criteria. The majority of studies (n=8) reported that eHealth PA interventions significantly improved PA, with the majority of studies also adopting self-report measures of PA (n=9). The questionnaire-based study showed that smartphone penetration in this sample was 60.8% overall, while only 17.6% (n=18) participants had knowledge of the recommended PA guidelines. Over 54% (n=56) reported their current PA and exercise as being below recommended guidelines. Themes identified from the focus group study included ?Health impact?, ?Support needs?, ?Goal setting? and ?Education needs?. Results from this study indicated that adequate training, education and support in both using technology, and adopting good PA behaviours, would be an important factor for participants in a future eHealth intervention. Results from the feasibility study indicated that the eHealth intervention that was conducted was safe, acceptable and feasible. Results also showed some initial efficacy in improving self-report PA (p < 0.0005) and quality of life (p=0.02).

Conclusion This research shows that an eHealth intervention, designed to impact PA through the use of Fitbit technology, was safe, acceptable and produced significant improvements in quality of life and subjective PA. The results from this thesis also provide researchers and clinicians with a base of knowledge and further insight into the burgeoning area of eHealth to promote PA in people with cancer.