Feasibility and effect of a physical activity counselling session with or without provision of an activity tracker on maintenance of physical activity in women with breast cancer — A randomised controlled trial

doi:10.1016/j.jsams.2019.09.019

Journal of Science and Medicine in Sport

Volume 23, Issue 3, March 2020, Pages 283-290

https://doi.org/10.1016/j.jsams.2019.09.019 Get rights and content

Abstract

Objectives

The SAFE-Maintain study sought to evaluate the effect and acceptability of a physical activity counselling (PAC) session, versus a PAC session plus provision of a Fitbit (Charge HR®; PAC + F), on maintenance of physical activity levels 12 weeks following participation in a supervised exercise intervention.

Design

Fifty-two women with stage II + breast cancer who had recently (within the previous 7 days) completed a 12-week supervised exercise program were randomised to the PAC or PAC + F group.

Methods

Physical activity levels, including weekly minutes of total physical activity (min/week), daily step count (steps/day), and weekly minutes of moderate to vigorous physical activity (MVPA, min/week), were assessed using the Active Australia survey and Actigraph® GT3X+ accelerometers. Self-reported outcomes were assessed at baseline and 12-week follow-up, while objectively-measured outcomes were only available at 12-week follow-up.

Results

Compared with the PAC group, the PAC + F group had higher self-reported MVPA and self-reported total activity (between-group mean difference: 78.2 [95% CI = −8.3, 164.9] min/week, p < 0.01, and 171.9 [95% CI = 46.1, 297.8] min/week, p < 0.01, respectively) at 12-week follow-up. Higher objectively-assessed MVPA (p = 0.03) and steps/day (p = 0.07) at 12-week follow-up was also observed in the PAC + F group compared with the PAC group. Most (>80%) of the PAC + F group reported high levels of Fitbit use and considered the device to be beneficial for physical activity maintenance.

Conclusions

Findings suggest that activity trackers show promise as an effective, feasible and acceptable approach to support physical activity maintenance following completion of a supervised exercise intervention.

Trial registration

Prospectively registered on the Australian and New Zealand Clinical Trials Registry (ANZCTR, Trial registration number: ACTRN12616000954426).

Section snippets

Practical implications

•
Provision of supervised exercise is insufficient for many breast cancer survivors in maintaining sufficient levels of physical activity longer term.
•
Physical activity trackers may be a useful, complementary tool to supervised exercise and physical activity counselling for supporting longer term behaviour change.
•
When using physical activity trackers to support physical activity maintenance, allied health professionals need to work with the patient to ensure they understand how the activity

Methods

This study involved a convenience sample of participants who had recently completed participation in a randomised controlled exercise intervention study (the SAFE trial, trial registration number: ACTRN12616000547448). The SAFE trial (n = 60) evaluated the effect of a 12-week intervention, with a weekly exercise target of 150 min of combined aerobic- and resistance-based exercise at moderate to high intensity, delivered over five (n = 30) or 20 (n = 30) supervised sessions (depending on randomisation)

Results

Fifty-four participants completed the SAFE trial and were eligible for entry into this follow-up study (Supplementary Fig. S1). Of these, two women refused consent (declined to participate due to disease progression, n = 1; declined to participate due to commencing new treatment, n = 1). A total of 52 women consented, completed baseline assessment and were subsequently randomised into the PAC + F or PAC group (Supplementary Fig. S1). Baseline demographic and clinical characteristics between the SAFE

Discussion

These findings suggest that those who received an activity tracker, alongside a one-off physical activity counselling session, had, on average, higher physical activity levels at 12-week follow-up, compared with participants who did not receive an activity tracker. Further, nearly two-thirds (64%) of those who did not receive the activity tracker showed clinically relevant reductions in their physical activity during the 12-week follow-up period, with the mean reduction in S-MVPA estimated at 81

Conclusion

The positive, albeit preliminary findings, highlight that activity trackers may be a cost-effective and feasible strategy for promotion of longer-term physical activity. As newer models of physical activity devices are released on the market regularly, with newer devices typically including innovative technology and features (e.g. extended battery life, individualised goal-setting) and updated designs, their potential for making a difference to physical activity levels may continue to improve.

Acknowledgements

We would like to acknowledge the contributions of the women participating in SAFE and SAFE-Maintain — without their willingness to participate these studies would not have possible. SH is supported by a research fellowship from the Cancer Council Queensland.

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This review, meta-analysis, and meta-regression aimed to (1) evaluate the effect of wearable-technology-assisted interventions on the physical activity and weight of breast cancer survivors, (2) identify the essential features of wearable-technology-assisted interventions, and (3) explore the covariates of the treatment effect.
Randomized controlled trials were obtained from 10 databases and trial registries from inception until December 21, 2021. Trials that examined the effects of wearable-technology-assisted interventions for individuals with breast cancer were included. The mean and standard deviation scores were used to compute the effect sizes.
The meta-analyses revealed significantly improved in moderate-to-vigorous activity, total physical activity, and weight control. The findings from this review suggest that wearable-technology-assisted interventions may be a potential solution to improve physical activity and weight in breast cancer survivors. Future studies should include high-quality trials with large sample sizes.
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Intervention durations ranged between 4 weeks41,60 and 1 year53 (median = 12 weeks). Most trials (n = 25, 71%) involved pedometer-based physical activity interventions,35,37–45,49, 50,52,53,55–57,60–62,64,65,67,69,70 7 trials (20%) involved Fitbit-based interventions,46,47,54,58,59,63,66 and 3 trials (9%) involved other wearable physical activity trackers (Polar36,51 and Garmin48). Intervention goals most commonly involved performing 30 min of low-to-moderate-intensity exercise (e.g., walking) at least 5 days/week38–40,42–45,52,62 or 150 min/week of moderate-intensity physical activity.36,41,46,47,49,50,54,63,67
This systematic review and meta-analysis aimed to evaluate the effect of wearable devices for improving physical activity and health-related outcomes in cancer survivors.
CINAHL, Cochrane, Ebscohost, MEDLINE, Pubmed, ProQuest Health and Medical Complete, ProQuest Nursing and Allied Health Source, ScienceDirect, and SPORTDiscus databases were searched for randomized controlled trials published before September 1, 2020, that evaluated interventions involving wearable devices in cancer survivors. Standardized mean differences (SMDs) were calculated to assess effects on physical activity and health-related outcomes. Subgroup analyses were conducted to assess whether the effects differed by interventions and cancer characteristics. Risk of bias was assessed using the Cochrane risk of bias tool.
Thirty-five trials were included (breast cancer, n = 15, 43%). Intervention durations ranged between 4 weeks and 1 year. Most trials (n = 25, 71%) involved pedometer-based physical activity interventions. Seven (20%) involved Fitbit-based interventions, and 3 (9%) involved other wearable physical activity trackers (e.g., Polar, Garmin). Compared to usual care, wearable devices had moderate-to-large effects (SMD range 0.54−0.87, p < 0.001) on moderate-intensity physical activity, moderate-to-vigorous-intensity physical activity, total physical activity, and daily steps. Compared to usual care, those in the intervention had higher quality of life, aerobic fitness, physical function, and reduced fatigue (SMD range = 0.18−0.66, all p < 0.05).
Wearable physical activity trackers and pedometers are effective tools that increase physical activity and improve health-related outcomes in individuals with cancer. Identifying how these devices can be implemented for longer-term use with other intervention components remains an area for future research.
Motivational strategies to improve adherence to physical activity in breast cancer survivors: A systematic review and meta-analysis
2021, Maturitas
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Overall, intervention group involved in meta-analysis can be categorized into three groups consisting of 1) pedometer + counselling, 2) pedometer + MI, and 3) pedometer + print material. Nine trials [37, 47, 50, 51, 53, 56-58, 60] were included in meta-analysis of MVPA duration (minutes per week). There was significant heterogeneity between studies (I2 =77%).
Two behavioral change-based strategies for promoting adherence to physical activity (PA) suggested to have the greatest potential are the pedometer and Motivational Interviewing (MI). However, there are no comparisons between these two strategies identifying which one is more effective for improving PA adherence. This systematic review and meta-analysis aimed to determine which PA motivation strategy is more effective for promoting adherence to self-directed PA in female breast cancer survivors. Studies implementing self-directed PA which used a step tracker and/or MI for motivation in female breast cancer survivors were identified from the following databases at two timepoints, September 2019 and June 2020: CENTRAL, PubMed, CINAHL, PsycINFO, and Sportdiscuss. Sixteen randomized controlled trials (RCTs) were selected for data extraction, whereas ten RCTs were included in meta-analysis. Meta-analysis was performed on pooled data to estimate the standardized mean differences in PA duration and step count, and 95% confidence intervals. The number of participants meeting PA recommendations was also analyzed. Subgroup analysis was performed for three motivational strategies (pedometer combined with counselling, with print material or with motivational interviewing). Meta-analysis showed that pedometer combined with another intervention has a small effect on step count (p = 0.03) and a moderate effect on duration of moderate-vigorous physical activity (MVPA) (p = <0.0001) compared to controls. Additionally, motivational strategies increase the number of participants who meet a PA goal (p = 0.005). The findings of this review endorse the use of a step tracker combined with counselling, print material or MI based on behavioral change theory. This approach provided the most consistent positive effect on adherence to self-directed PA among breast cancer survivors. Future studies should evaluate differences between measures of adherence to self-directed PA, to identify the best motivation strategy for improving patient adherence and health outcomes.
Systematic review registration: PROSPERO Registration number CRD42020148542
Physical activity levels in women with stage II or higher breast cancer: Association, difference and agreement between self-report and objective measurement methods
2021, Science and Sports
To help women with breast cancer (BC) be sufficiently active, accurate assessment of physical activity (PA) is important. This study compared self-reported and objectively-assessed PA in women with stage II+ BC.
Moderate-to-vigorous-intensity physical activity (MVPA) was assessed objectively using accelerometery (Actigraph® GT3X+) and using self-report (Active Australia Survey) and reported in weekly metabolic equivalent minutes (MET.min/wk). Associations, difference and agreement between methods were evaluated using Spearman's correlation, Wilcoxon signed-rank test and Bland-Altman analyses, respectively. Women were also categorised as being insufficiently (≤ 450 MET.min/wk) or sufficiently active (> 450 MET.min/wk) and compared using Cohen's Kappa.
Participants (n = 50) were 51 ± 9 years, with a mean body mass index of 29 ± 6 kg/m². Self-reported and objectively-assessed MVPA were moderately correlated (r = 0.46, P < 0.01). Median MVPA was similar across methods (self-reported: median = 1085.1 [Interquartile range, IQR = 1032.2] MET.min/wk; objectively-assessed: median = 888.4 [IQR = 1218.5] MET.min/wk; P = 0.74), with wide limits of agreement (±2588.6 MET.min/wk).
Self-reported MVPA using the Active Australia survey is comparable with objective assessments. For most who self-reported PA levels consistent with national guidelines, their objectively-assessed PA confirmed this to be true. Self-report methods can be used to identify women who need encouragement to stay active versus those who need targeted advice.
Pour aider les femmes atteintes d’un cancer du sein (CS) à être suffisamment actives, une évaluation précise de l’activité physique (AP) est importante. Cette étude a pour objectif de comparer l’AP auto-déclarée et objectivement évaluée chez les femmes au stade II + CS.
L’AP d’intensité modérée à vigoureuse (APMV) a été évaluée objectivement par accélérométrie (Actigraph® GT3X+) et par auto-déclaration (Active Australia Survey), et rapportée en minutes équivalentes métaboliques hebdomadaires (MET.min/semaine). Les associations, les différences et la concordance entre les méthodes ont été respectivement évaluées à l’aide de la corrélation de Spearman, du test du rang de Wilcoxon et des analyses de Bland-Altman. Les femmes ont également été classées comme étant insuffisamment (< 450 MET.min/semaine) ou suffisamment actives (> 450 MET.min/semaine) et comparées en utilisant le Kappa de Cohen.
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L’APMV auto-déclarée à l’aide de l’enquête Active Australia est comparable aux évaluations objectives. Pour la plupart des personnes ayant déclaré des niveaux d’AP conformes aux directives nationales, leur AP objectivement évaluée a confirmé que c’était le cas. Les méthodes d’auto-évaluation peuvent être utilisées pour identifier les femmes qui auraient besoin d’encouragements afin de rester physiquement actives par rapport à celles qui auraient besoin de conseils ciblés.
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Original researchFeasibility and effect of a physical activity counselling session with or without provision of an activity tracker on maintenance of physical activity in women with breast cancer — A randomised controlled trial

Abstract

Objectives

Design

Methods

Results

Conclusions

Trial registration

Section snippets

Practical implications

Methods

Results

Discussion

Conclusion

Acknowledgements

J Subst Abuse Treat

Gynecol Oncol

Organ Behav Hum Decis Process

J Sci Med Sport

Aust N Z J Public Health

An update of controlled physical activity trials in cancer survivors: a systematic review and meta-analysis

J Cancer Surviv

Randomized trial of exercise therapy in women treated for breast cancer

J Clin Oncol

Self-reported physical activity behavior of breast cancer survivors during and after adjuvant therapy: 12 months follow-up of two randomized exercise intervention trials

Acta Oncol

Exercise following breast cancer: exploratory survival analyses of two randomised, controlled trials

Breast Cancer Res Treat

Use of theory in behavior change interventions: an analysis of programs to increase physical activity in posttreatment breast cancer survivors

Health Educ Behav

Physical activity and/or dietary interventions in breast cancer survivors: a systematic review of the maintenance of outcomes

J Cancer Surviv

Wearable tech device awareness surpasses 50 percent among us consumers, according to NDP

Breast cancer survivors’ preferences for technology-supported exercise interventions

Support Care Cancer

Best fitness trackers 2016: Fitbit, Garmin, Misfit and more

Acceptability of Fitbit for physical activity tracking within clinical care among men with prostate cancer

AMIA Annu Symp Proc

A Fitbit and Facebook mHealth intervention for promoting physical activity among adolescent and young adult childhood cancer survivors: a pilot study

Pediatr Blood Cancer

Original research
Feasibility and effect of a physical activity counselling session with or without provision of an activity tracker on maintenance of physical activity in women with breast cancer — A randomised controlled trial