Carrie R. Howell
A web-based intervention helped adolescent survivors of childhood cancer increase their levels of moderate to vigorous physical activity, according to results of a randomized controlled trial scheduled for presentation at the Cancer Survivorship Symposium.
Increased activity levels appeared to have positive effects on survivors’ fitness, health-related quality of life and neurocognitive outcomes.
“Survivors of childhood cancer are at increased risk for obesity and metabolic syndrome, which may be remediated with regular physical activity,” Carrie R. Howell, PhD, clinical research scientist at St. Jude Children’s Research Hospital, said during a press conference. “However, there is a need to design creative and engaging interventions that may motivate young survivors to initiate, engage in and maintain physical activity.”
Howell and colleagues conducted a 24-week pilot study to assess whether a reward-based intervention delivered over the internet would increase physical activity, as well as improve fitness, cognition and quality of life.
Researchers enrolled 97 cancer survivors aged 11 to 15 years (mean age, 12.7 years), all of whom had completed cancer treatment at St. Jude and exercised less than 60 minutes per day. Approximately 25% of study participants had undergone treatment for acute lymphoblastic leukemia; 80% were white; and 55.1% were female.
All study participants visited St. Jude at the beginning and end of the study for assessments of their physical fitness, including strength, endurance and flexibility. Assessments also examined health-related quality of life, measured through the Pediatric Quality of Life Inventory questionnaire, and neurocognitive measures, such as memory and attention.
Researchers randomly assigned study participants 2:1 to an intervention group or a control group.
Those in the control group received an educational handout that included information about the importance of physical activity, examples of ways to get physical activity, and a wearable activity monitor.
Those assigned the intervention received an activity monitor and the same educational materials, plus access to an interactive, age-appropriate website.
Each week, participants assigned the intervention would connect their activity monitor to their computer and log their activity through the website. They received rewards — such as gift cards or T-shirts — by mail each time they reached certain activity thresholds.
The analysis included 78 survivors (intervention, n = 53; control, n = 25).
The time survivors spent performing moderate to vigorous physical activity increased by an average of 4.7 minutes (standard deviation, 119.9) per week in the intervention group and decreased by an average of 24.3 minutes (standard deviation, 89.7) per week in the control group.
Howell and colleagues observed improvement in several other measures in the intervention group, including average hand grip strength (21 kg after study completion vs. 19.9 kg at baseline; P = .01), average number of push-ups completed (18 vs. 15; P < .01), average number of sit-ups completed (14 vs. 11; P < .01) and verbal executive function (P < .01).
Results also showed improvements in health-related quality of life (78 vs. 74.2; P = .01). Researchers reported no improvement in those measures within the control group.
“In this age group, it is common to see a decrease in physical activity over time, even among healthy kids,” Howell said in a press release. “Therefore, we are encouraged that our intervention was successful at maintaining physical activity levels, but a longer program may be needed to create lasting exercise habits.”
Based on results of the pilot study, Howell and colleagues designed the larger ALTE1631 clinical trial to further investigate the potential benefits of a 1-year web-based physical activity intervention. Follow-up assessments would occur at 18 months.
The study is open for recruitment. Researchers hope to enroll 384 survivors (age range, 8 to 15 years) of childhood ALL for the ALTE1631 trial.
The investigators also hope to further assess the association between physical activity and cognition among childhood cancer survivors. – by Mark Leiser
Howell CR, et al. Abstract 102. Scheduled for presentation at: Cancer Survivorship Symposium; Feb. 16-17, 2018; Orlando, Fla.
Disclosures: Grants from NCI and American Lebanese Syrian Associated Charities supported this study. One author reports consultant or advisory roles with Coleman Supportive Oncology Initiative for Children with Cancer, Oncology Research Information Exchange Network, Pfizer and Princess Maxima Center. The other authors report no relevant financial disclsoures.