Abstract
To determine the feasibility, acceptability and preliminary efficacy of an eHealth intervention with charity-based incentives to increase physical activity (PA) among young adult cancer survivors. Participants were randomized into two groups: PA (N = 25; Fitbit, step goal, electronic weekly newsletter) or PA + Charity (N = 26; same as PA plus charity donation if step goal achieved). At baseline and 12 weeks, steps/day were assessed using an activPAL. Motivation (e.g., BREQ-3) and patient reported outcomes (e.g., sleep quality, fatigue) were self-reported. The mean age was 36.8 years, 56.9% were Non-Hispanic White. We retained 82% (42/51) of participants. The PA + Charity vs. PA group had significantly higher satisfaction with intervention experience (100% vs 85%), greater increases in steps/day (1689 vs 516) and increases in overall self-determination score (13.5 vs 2.2). Both groups significantly improved sleep quality and reduced fatigue. A low-intensity eHealth intervention with charity-based incentives was feasible, acceptable, increased PA and self-determination.
Trial registration Clinicaltrials.gov NCT03322059.
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References
Awick, E. A., Phillips, S. M., Lloyd, G. R., & McAuley, E. (2016). Physical activity, self-efficacy and self-esteem in breast cancer survivors: A panel model. Psycho-Oncology. https://doi.org/10.1002/pon.4180
Bachireddy, C., Joung, A., John, L. K., Gino, F., Tuckfield, B., Foschini, L., & Milkman, K. L. (2019). Effect of different financial incentive structures on promoting physical activity among adults: A randomized clinical trial. JAMA Network Open, 2, e199863. https://doi.org/10.1001/jamanetworkopen.2019.9863
Ballard-Barbash, R., Friedenreich, C. M., Courneya, K. S., Siddiqi, S. M., McTiernan, A., & Alfano, C. M. (2012). Physical activity, biomarkers, and disease outcomes in cancer survivors: A systematic review. Journal of the National Cancer Institute, 104, 815–840. https://doi.org/10.1093/jnci/djs207
Bandura, A. (2004). Health promotion by social cognitive means. Health Education & Behavior, 31, 143–164. https://doi.org/10.1177/1090198104263660
Brickwood, K. J., Watson, G., O’Brien, J., & Williams, A. D. (2019). Consumer-based wearable activity trackers increase physical activity participation: Systematic review and meta-analysis. JMIR mHealth and uHealth, 7, e11819. https://doi.org/10.2196/11819
Buman, M. P., Mullane, S. L., Toledo, M. J., Rydell, S. A., Gaesser, G. A., Crespo, N. C., Hannan, P., Feltes, L., Vuong, B., & Pereira, M. A. (2017). An intervention to reduce sitting and increase light-intensity physical activity at work: Design and rationale of the “Stand & Move at Work” group randomized trial. Contemporary Clinical Trials, 53, 11–19. https://doi.org/10.1016/j.cct.2016.12.008
Buysse, D. J., Reynolds, C. F., 3rd., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Research, 28, 193–213. https://doi.org/10.1016/0165-1781(89)90047-4
Campbell, K. L., Winters-Stone, K. M., Wiskemann, J., May, A. M., Schwartz, A. L., Courneya, K. S., Zucker, D. S., Matthews, C. E., Ligibel, J. A., Gerber, L. H., Morris, G. S., Patel, A. V., Hue, T. F., Perna, F. M., & Schmitz, K. H. (2019). Exercise guidelines for cancer survivors: Consensus Statement from International Multidisciplinary Roundtable. Medicine and Science in Sports and Exercise, 51, 2375–2390. https://doi.org/10.1249/MSS.0000000000002116
Cohen, J. (1988). Statistical power analyses for the behavioral sciences. Academic Press.
Coups, E. J., & Ostroff, J. S. (2005). A population-based estimate of the prevalence of behavioral risk factors among adult cancer survivors and noncancer controls. Preventive Medicine, 40, 702–711. https://doi.org/10.1016/j.ypmed.2004.09.011
Devine, K. A., Viola, A. S., Coups, E. J., & Wu, Y. P. (2018). Digital health interventions for adolescent and young adult cancer survivors. JCO Clinical Cancer Informatics, 2, 1–15. https://doi.org/10.1200/CCI.17.00138
Finkelstein, E. A., Haaland, B. A., Bilger, M., Sahasranaman, A., Sloan, R. A., Nang, E. E., & Evenson, K. R. (2016). Effectiveness of activity trackers with and without incentives to increase physical activity (TRIPPA): A randomised controlled trial. The Lancet Diabetes and Endocrinology, 4, 983–995. https://doi.org/10.1016/S2213-8587(16)30284-4
Garcia, S. F., Cella, D., Clauser, S. B., Flynn, K. E., Lad, T., Lai, J. S., Reeve, B. B., Smith, A. W., Stone, A. A., & Weinfurt, K. (2008). Standardizing patient-reported outcomes assessment in cancer clinical trials: A patient-reported outcomes measurement information system initiative (vol 25, pg 5106, 2007). Journal of Clinical Oncology, 26, 1018–1018. https://doi.org/10.1200/Jco.2008.16.1992
Goode, A. P., Hall, K. S., Batch, B. C., Huffman, K. M., Hastings, S. N., Allen, K. D., Shaw, R. J., Kanach, F. A., McDuffie, J. R., Kosinski, A. S., Williams, J. W., & Gierisch, J. M. (2017). The impact of interventions that integrate accelerometers on physical activity and weight loss: A systematic review. Annals of Behavioral Medicine, 51, 79–93. https://doi.org/10.1007/s12160-016-9829-1
Harkins, K. A., Kullgren, J. T., Bellamy, S. L., Karlawish, J., & Glanz, K. (2017). A trial of financial and social incentives to increase older adults’ walking. American Journal of Preventive Medicine, 52, e123–e130. https://doi.org/10.1016/j.amepre.2016.11.011
Healy, G. N., Eakin, E. G., Owen, N., Lamontagne, A. D., Moodie, M., Winkler, E. A., Fjeldsoe, B. S., Wiesner, G., Willenberg, L., & Dunstan, D. W. (2016). A cluster randomized controlled trial to reduce office workers’ sitting time: Effect on activity outcomes. Medicine and Science in Sports and Exercise, 48, 1787–1797. https://doi.org/10.1249/MSS.0000000000000972
Heo, J., Chun, S., Lee, S., & Kim, J. (2016). Life satisfaction and psychological well-being of older adults with cancer experience: The role of optimism and volunteering. International Journal of Aging and Human Development, 83, 274–289. https://doi.org/10.1177/0091415016652406
Kampshoff, C. S., Stacey, F., Short, C. E., van Mechelen, W., Chinapaw, M. J., Brug, J., Plotnikoff, R., James, E. L., & Buffart, L. M. (2016). Demographic, clinical, psychosocial, and environmental correlates of objectively assessed physical activity among breast cancer survivors. Supportive Care in Cancer, 24, 3333–3342. https://doi.org/10.1007/s00520-016-3148-8
Kendzierski, D., & DeCarlo, K. J. (1991). Physical Activity Enjoyment Scale: Two validation studies. Journal of Sport & Exercise Psychology, 13, 50–64.
Kozey-Keadle, S., Libertine, A., Lyden, K., Staudenmayer, J., & Freedson, P. S. (2011). Validation of wearable monitors for assessing sedentary behavior. Medicine and Science in Sports and Exercise, 43, 1561–1567. https://doi.org/10.1249/MSS.0b013e31820ce174
Kozey-Keadle, S., Staudenmayer, J., Libertine, A., Mavilia, M., Lyden, K., Braun, B., & Freedson, P. (2014). Changes in sedentary time and physical activity in response to an exercise training and/or lifestyle intervention. Journal of Physical Activity & Health, 11, 1324–1333. https://doi.org/10.1123/jpah.2012-0340
Leach, C. R., Weaver, K. E., Aziz, N. M., Alfano, C. M., Bellizzi, K. M., Kent, E. E., Forsythe, L. P., & Rowland, J. H. (2015). The complex health profile of long-term cancer survivors: Prevalence and predictors of comorbid conditions. Journal of Cancer Survivorship, 9, 239–251. https://doi.org/10.1007/s11764-014-0403-1
Ledger, D., & McCaffrey D. (2014). Inside wearables: How the science of human behaviour change off ers the secret to long-term engagement. (Part 2). Retrieved from https://endeavourpartners.net/assets/Endeavour-Partners-Inside-Wearables-Part-2-July-2014.pdf
Lyden, K., Keadle, S. K., Staudenmayer, J., & Freedson, P. S. (2016). The activPAL TM accurately classifies activity intensity categories in healthy adults. Medicine and Science in Sports and Exercise. https://doi.org/10.1249/MSS.0000000000001177
Lynch, B. M., Nguyen, N. H., Moore, M. M., Reeves, M. M., Rosenberg, D. E., Boyle, T., Vallance, J. K., Milton, S., Friedenreich, C. M., & English, D. R. (2019). A randomized controlled trial of a wearable technology-based intervention for increasing moderate to vigorous physical activity and reducing sedentary behavior in breast cancer survivors: The ACTIVATE Trial. Cancer, 125, 2846–2855. https://doi.org/10.1002/cncr.32143
Mailey, E. L., Phillips, S. M., Dlugonski, D., & Conroy, D. E. (2016). Overcoming barriers to exercise among parents: A social cognitive theory perspective. Journal of Behavioral Medicine, 39, 599–609. https://doi.org/10.1007/s10865-016-9744-8
Markland, D., & Tobin, V. (2004). A modification to the behavioural regulation in exercise questionnaire to include an assessment of amotivation. Journal of Sport & Exercise Psychology, 26, 191–196. https://doi.org/10.1123/jsep.26.2.191
McAuley, E. (1992). Self-efficacy and the maintenance of exercise participation in older adults. Journal of Behavioral Medicine, 15, 65–88. https://doi.org/10.1007/Bf00844757
Mendoza, J. A., Baker, K. S., Moreno, M. A., Whitlock, K., Abbey-Lambertz, M., Waite, A., Colburn, T., & Chow, E. J. (2017). A Fitbit and Facebook mHealth intervention for promoting physical activity among adolescent and young adult childhood cancer survivors: A pilot study. Pediatric Blood & Cancer, 64, e26660. https://doi.org/10.1002/pbc.26660
Mercer, K., Li, M., Giangregorio, L., Burns, C., & Grindrod, K. (2016). Behavior change techniques present in wearable activity trackers: A critical analysis. JMIR mHealth and uHealth, 4, e40. https://doi.org/10.2196/mhealth.4461
Miropolsky, E. M., Baker, K. S., Abbey-Lambertz, M., Syrjala, K., Chow, E. J., Ceballos, R., & Mendoza, J. A. (2020). Participant perceptions on a fitbit and facebook intervention for young adult cancer survivors: A qualitative study. Journal of Adolescent and Young Adult Oncology. https://doi.org/10.1089/jayao.2019.0072
Mitchell, M., Orstad, S. L., Biswas, A., Faulkner, G., Adams, M. A., & Jay, M. (2018). Financial incentives for physical activity in adults: An updated systematic review and meta-analysis. Annals of Behavioral Medicine, 52, S299–S299.
Mollayeva, T., Thurairajah, P., Burton, K., Mollayeva, S., Shapiro, C. M., & Colantonio, A. (2016). The Pittsburgh sleep quality index as a screening tool for sleep dysfunction in clinical and non-clinical samples: A systematic review and meta-analysis. Sleep Medicine Reviews, 25, 52–73. https://doi.org/10.1016/j.smrv.2015.01.009
Nass, S. J., Beaupin, L. K., Demark-Wahnefried, W., Fasciano, K., Ganz, P. A., Hayes-Lattin, B., Hudson, M. M., Nevidjon, B., Oeffinger, K. C., Rechis, R., Richardson, L. C., Seibel, N. L., & Smith, A. W. (2015). Identifying and addressing the needs of adolescents and young adults with cancer: Summary of an Institute of Medicine workshop. The Oncologist, 20, 186–195. https://doi.org/10.1634/theoncologist.2014-0265
Ness, K. K., Leisenring, W. M., Huang, S. J., Hudson, M. M., Gurney, J. G., Whelan, K., Hobbie, W. L., Armstrong, G. T., Robison, L. L., & Oeffinger, K. C. (2009). Predictors of inactive lifestyle among adult survivors of childhood cancer A report from the childhood cancer survivor study. Cancer, 115, 1984–1994. https://doi.org/10.1002/cncr.24209
Patel, A. V., Friedenreich, C. M., Moore, S. C., Hayes, S. C., Silver, J. K., Campbell, K. L., Winters-Stone, K., Gerber, L. H., George, S. M., Fulton, J. E., Denlinger, C., Stephen Morris, G., Hue, T., Schmitz, K. H., & Matthews, C. E. (2019). American College of Sports Medicine Roundtable Report on physical activity, sedentary behavior, and cancer prevention and control. Medicine and Science in Sports and Exercise, 51, 2391–2402. https://doi.org/10.1249/MSS.0000000000002117
Patrick, H., & Williams, G. C. (2012). Self-determination theory: Its application to health behavior and complementarity with motivational interviewing. International Journal of Behavioral Nutrition and Physical Activity, 9, 18. https://doi.org/10.1186/1479-5868-9-18
Phillips, S. M., Alfano, C. M., Perna, F. M., & Glasgow, R. E. (2014). Accelerating translation of physical activity and cancer survivorship research into practice: Recommendations for a more integrated and collaborative approach. Cancer Epidemiology, Biomarkers & Prevention, 23, 687–699. https://doi.org/10.1158/1055-9965.EPI-13-1355
Phillips, S. M., & McAuley, E. (2013). Social cognitive influences on physical activity participation in long-term breast cancer survivors. Psycho-Oncology, 22, 783–791. https://doi.org/10.1002/pon.3074
Phillips, S. M., & McAuley, E. (2014). Physical activity and quality of life in breast cancer survivors: The role of self-efficacy and health status. Psycho-Oncology, 23, 27–34. https://doi.org/10.1002/pon.3366
Ramsey, W. A., Heidelberg, R. E., Gilbert, A. M., Heneghan, M. B., Badawy, S. M., & Alberts, N. M. (2020). eHealth and mHealth interventions in pediatric cancer: A systematic review of interventions across the cancer continuum. Psycho-Oncology, 29, 17–37. https://doi.org/10.1002/pon.5280
Rovniak, L. S., Anderson, E. S., Winett, R. A., & Stephens, R. S. (2002). Social cognitive determinants of physical activity in young adults: A prospective structural equation analysis. Annals of Behavioral Medicine, 24, 149–156. https://doi.org/10.1207/S15324796abm2402_12
Rugbjerg, K., Mellemkjaer, L., Boice, J. D., Kober, L., Ewertz, M., & Olsen, J. H. (2014). Cardiovascular disease in survivors of adolescent and young adult cancer: A Danish Cohort Study, 1943–2009. JNCI-Journal of the National Cancer Institute. https://doi.org/10.1093/jnci/dju110
Ryan, R. M., & Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist, 55, 68–78. https://doi.org/10.1037/0003-066x.55.1.68
Sallis, J. F., Grossman, R. M., Pinski, R. B., Patterson, T. L., & Nader, P. R. (1987). The development of scales to measure social support for diet and exercise behaviors. Preventive Medicine, 16, 825–836.
Swain, C. T. V., Nguyen, N. H., Eagles, T., Vallance, J. K., Boyle, T., Lahart, I. M., & Lynch, B. M. (2020). Postdiagnosis sedentary behavior and health outcomes in cancer survivors: A systematic review and meta-analysis. Cancer, 126, 861–869. https://doi.org/10.1002/cncr.32578
Teixeira, P. J., Carraca, E. V., Markland, D., Silva, M. N., & Ryan, R. M. (2012). Exercise, physical activity, and self-determination theory: A systematic review. International Journal of Behavioral Nutrition and Physical Activity, 9, 78. https://doi.org/10.1186/1479-5868-9-78
Toth, L. P., Park, S., Springer, C. M., Feyerabend, M. D., Steeves, J. A., & Bassett, D. R. (2018). Video-recorded validation of wearable step counters under free-living conditions. Medicine and Science in Sports and Exercise, 50, 1315–1322. https://doi.org/10.1249/MSS.0000000000001569
Troiano, R. P., Berrigan, D., Dodd, K. W., Masse, L. C., Tilert, T., & McDowell, M. (2008). Physical activity in the United States measured by accelerometer. Medicine & Science in Sports & Exercise, 40, 181–188.
Umstattd Meyer, M. R., Meyer, A. R., Wu, C., & Bernhart, J. (2018). When hel** helps: Exploring health benefits of cancer survivors participating in for-cause physical activity events. BMC Public Health, 18, 663. https://doi.org/10.1186/s12889-018-5559-6
Weiner, L. S., Takemoto, M., Godbole, S., Nelson, S. H., Natarajan, L., Sears, D. D., & Hartman, S. J. (2019). Breast cancer survivors reduce accelerometer-measured sedentary time in an exercise intervention. Journal of Cancer Survivorship, 13, 468–476. https://doi.org/10.1007/s11764-019-00768-8
Wójcicki, T. R., White, S. M., & McAuley, E. (2009). Assessing outcome expectations in older adults: The multidimensional outcome expectations for exercise scale. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 64, 33–40.
Wojcicki, T. R., White, S. M., & McAuley, E. (2009). Assessing outcome expectations in older adults: The multidimensional outcome expectations for exercise scale. Journals of Gerontology Series B-Psychological Sciences and Social Sciences, 64, 33–40. https://doi.org/10.1093/geronb/gbn032
Acknowledgements
We would like to thank the study participants and the cancer support networks for sharing the recruitment materials.
Funding
This project supported by the Research, Scholarly and Creative Activities Grant at California Polytechnic State University and the William and Linda Frost Fund. Dr. Phillips is supported by The National Cancer Institute K07CA196840.
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Dr. Phelan reports receiving a grant from WW unrelated to the current work. Sarah Kozey Keadle, Leah Meuter and Siobhan M. Phillips declare that they have no other conflicts of interest.
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The study complies with ethical standards for the protection of human subjects. All study procedures were approved by the Califorina Polytechnic Institutional Review Board (Protocol # 2018–188-CP) and participants provided written informed consent. The study is registered as NCT03322059 at clinicaltrials.gov.
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Keadle, S.K., Meuter, L., Phelan, S. et al. Charity-based incentives motivate young adult cancer survivors to increase physical activity: a pilot randomized clinical trial. J Behav Med 44, 682–693 (2021). https://doi.org/10.1007/s10865-021-00218-w
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DOI: https://doi.org/10.1007/s10865-021-00218-w