Fitbits, Facebook help childhood cancer survivors embrace more active lifestyle

Eric J. Chow

Adolescent and young adult survivors of childhood cancer appeared receptive to an intervention that used Fitbit tracking and a Facebook support group to increase levels of physical activity, according to results of a randomized controlled pilot study.

Physical activity may help prevent chronic diseases among childhood cancer survivors. However, randomized controlled trials are necessary to determine the most effective ways to increase physical activity in this population, according to study background.

Eric J. Chow, MD, MPH — assistant professor in the division of hematology and oncology, and medical director of the childhood cancer survivor program at Seattle Children’s Hospital — and colleagues enrolled 60 cancer survivors aged 14 to 18 years who had completed cancer treatment at least 1 year earlier.

Researchers randomly assigned participants to a 10-week program that compared a mobile health intervention — which used Fitbit activity trackers and Facebook to encourage survivors to become more physically active — with usual care.

Participants underwent baseline assessment and follow-up assessments during weeks 8 and 10.

Survivors assigned to the intervention arm wore Fitbit trackers on 71% of intervention days, and approximately 90% joined the study’s private Facebook page, designed to provide peer-based virtual support.

Exploratory analyses showed no significant differences in amounts of moderate to vigorous physical activity or sedentary time between the intervention and control groups.

However, qualitative data “confirmed intervention acceptability,” researchers wrote. Investigators also observed modest improvement in select subscales of quality of life and motivation for physical activity among those in the intervention group.

“This mobile health physical activity intervention was feasible and acceptable to adolescent and young adult childhood cancer survivors,” Chow and colleagues wrote.

Based on their findings, researchers wrote that “a fully powered randomized controlled trial” is warranted.

HemOnc Today spoke with Chow about the study results and their implications, and his research team’s desire to conduct a larger randomized trial to better assess the potential benefits of this intervention.

Question: What prompted this study?

Answer: Childhood cancer survivors are at increased risk for heart disease, and previously published studies showed this population is less physically active. We sought to test whether a physical activity intervention could increase activity among teenage childhood cancer survivors.

Q: How did you conduct the study?

A: Because this was a pilot study, we only had the funds to enroll about 60 participants. We randomly assigned half of these participants to the intervention arm; they received a Fitbit device and joined a private Facebook group. We assigned the other half to a control arm, and they received standard health information only. The main focus of our study was to see if teenage cancer survivors would be interested in participating in a study like this — in other words, how easy was it to recruit participants? Second, we wanted to see if they would agree to use the Fitbit for 10 weeks and join the private Facebook group. Third, we wanted to see if we could measure physical activity at baseline and at the end of the study.

Q: What did you find?

A: The paper clearly showed participants were very interested in wearing the Fitbits and participating in the private Facebook group. We did not have to work too hard to achieve our enrollment goal. People signed up quickly, so this shows a study like this is feasible, and that teens are willing to wear and use the Fitbit. There was limited engagement on Facebook but, at the same time, almost all patients assigned to the intervention group did sign up for the Facebook group. These results show teenaged cancer survivors would be willing to participate in an intervention like this. Of note, we did not show much difference in physical activity levels between the two study groups. However, we did not expect to see a significant increase in physical activity levels, as this was a very small group of patients and our intervention was relatively short at only 10 weeks.

Q: What are the potential benefits of this type of approach?

A: People may become more interested and more aware of how much physical activity they are getting and — if they are not getting that much — increase their level. Prior research from other groups suggested that many childhood cancer survivors would like to meet others who have gone through what they went through. Connecting people who went through childhood cancer treatments via a private Facebook group is one way to provide peer support. We thought this could have additional benefits and make participants feel more connected.

Q: Did the results surprise you?

A: Yes. Internet use is very age- and time-specific. By the time we got approvals and funding and actually started the study, Facebook was no longer as popular in this age group. Teenagers report favoring other social media platforms, such as Instagram and Snapchat. At the same time, we were able to get the majority of participants to sign up, and we knew most participants viewed at least some of the study posts and commented on them. We also found that study engagement with Facebook seemed to vary depending on how recently someone had been treated. We think the patients who underwent treatment more recently felt more connected to their cancer experience, so they felt more motivated to engage with other survivors.

Q: Do you plan to conduct additional research?

A: We plan to try a longer intervention. Most lifestyle interventions tend to be at least 3 months to 4 months, if not longer, so this will be our goal. Also, considering the feedback we received, we will look into whether we can use something either as a supplement to or in place of Facebook. The primary goal of our study was feasibility, and we tried to make the eligibility broad. We did not exclude those who already exercised a lot. We had participants who were on their varsity soccer teams and, therefore, did not need to benefit from a physical activity intervention. A future study would be restricted to those who were not very physically active.

Q: Would you like to mention anything else?

A: This was a fun study to be a part of. I got the sense that participants liked it, too, which is always helpful when trying to deploy something like this on a broader basis. We know members of this population are not very active — and potentially even less active than their peers who are not cancer survivors. Trying to establish a healthier lifestyle at a relatively young age helps these individuals to set certain lifestyle preferences when they are older. – by Jennifer Southall

Reference:

Mendoza JA, et al. Pediatr Blood Cancer. 2017;doi:10.1002/pbc.26660.

For more information:

Eric J. Chow, MD, MP H, can be reached at Seattle Children’s Hospital, 4800 Sand Point Way NE, Seattle, WA 98105; email: ericchow@uw.edu.

Disclosure: Chow reports no relevant financial disclosures.

Eric J. Chow

Adolescent and young adult survivors of childhood cancer appeared receptive to an intervention that used Fitbit tracking and a Facebook support group to increase levels of physical activity, according to results of a randomized controlled pilot study.

Physical activity may help prevent chronic diseases among childhood cancer survivors. However, randomized controlled trials are necessary to determine the most effective ways to increase physical activity in this population, according to study background.

Eric J. Chow, MD, MPH — assistant professor in the division of hematology and oncology, and medical director of the childhood cancer survivor program at Seattle Children’s Hospital — and colleagues enrolled 60 cancer survivors aged 14 to 18 years who had completed cancer treatment at least 1 year earlier.

Researchers randomly assigned participants to a 10-week program that compared a mobile health intervention — which used Fitbit activity trackers and Facebook to encourage survivors to become more physically active — with usual care.

Participants underwent baseline assessment and follow-up assessments during weeks 8 and 10.

Survivors assigned to the intervention arm wore Fitbit trackers on 71% of intervention days, and approximately 90% joined the study’s private Facebook page, designed to provide peer-based virtual support.

Exploratory analyses showed no significant differences in amounts of moderate to vigorous physical activity or sedentary time between the intervention and control groups.

However, qualitative data “confirmed intervention acceptability,” researchers wrote. Investigators also observed modest improvement in select subscales of quality of life and motivation for physical activity among those in the intervention group.

“This mobile health physical activity intervention was feasible and acceptable to adolescent and young adult childhood cancer survivors,” Chow and colleagues wrote.

Based on their findings, researchers wrote that “a fully powered randomized controlled trial” is warranted.

HemOnc Today spoke with Chow about the study results and their implications, and his research team’s desire to conduct a larger randomized trial to better assess the potential benefits of this intervention.

Question: What prompted this study?

Answer: Childhood cancer survivors are at increased risk for heart disease, and previously published studies showed this population is less physically active. We sought to test whether a physical activity intervention could increase activity among teenage childhood cancer survivors.

Q: How did you conduct the study?

A: Because this was a pilot study, we only had the funds to enroll about 60 participants. We randomly assigned half of these participants to the intervention arm; they received a Fitbit device and joined a private Facebook group. We assigned the other half to a control arm, and they received standard health information only. The main focus of our study was to see if teenage cancer survivors would be interested in participating in a study like this — in other words, how easy was it to recruit participants? Second, we wanted to see if they would agree to use the Fitbit for 10 weeks and join the private Facebook group. Third, we wanted to see if we could measure physical activity at baseline and at the end of the study.

PAGE BREAK

Q: What did you find?

A: The paper clearly showed participants were very interested in wearing the Fitbits and participating in the private Facebook group. We did not have to work too hard to achieve our enrollment goal. People signed up quickly, so this shows a study like this is feasible, and that teens are willing to wear and use the Fitbit. There was limited engagement on Facebook but, at the same time, almost all patients assigned to the intervention group did sign up for the Facebook group. These results show teenaged cancer survivors would be willing to participate in an intervention like this. Of note, we did not show much difference in physical activity levels between the two study groups. However, we did not expect to see a significant increase in physical activity levels, as this was a very small group of patients and our intervention was relatively short at only 10 weeks.

Q: What are the potential benefits of this type of approach?

A: People may become more interested and more aware of how much physical activity they are getting and — if they are not getting that much — increase their level. Prior research from other groups suggested that many childhood cancer survivors would like to meet others who have gone through what they went through. Connecting people who went through childhood cancer treatments via a private Facebook group is one way to provide peer support. We thought this could have additional benefits and make participants feel more connected.

Q: Did the results surprise you?

A: Yes. Internet use is very age- and time-specific. By the time we got approvals and funding and actually started the study, Facebook was no longer as popular in this age group. Teenagers report favoring other social media platforms, such as Instagram and Snapchat. At the same time, we were able to get the majority of participants to sign up, and we knew most participants viewed at least some of the study posts and commented on them. We also found that study engagement with Facebook seemed to vary depending on how recently someone had been treated. We think the patients who underwent treatment more recently felt more connected to their cancer experience, so they felt more motivated to engage with other survivors.

PAGE BREAK

Q: Do you plan to conduct additional research?

A: We plan to try a longer intervention. Most lifestyle interventions tend to be at least 3 months to 4 months, if not longer, so this will be our goal. Also, considering the feedback we received, we will look into whether we can use something either as a supplement to or in place of Facebook. The primary goal of our study was feasibility, and we tried to make the eligibility broad. We did not exclude those who already exercised a lot. We had participants who were on their varsity soccer teams and, therefore, did not need to benefit from a physical activity intervention. A future study would be restricted to those who were not very physically active.

Q: Would you like to mention anything else?

A: This was a fun study to be a part of. I got the sense that participants liked it, too, which is always helpful when trying to deploy something like this on a broader basis. We know members of this population are not very active — and potentially even less active than their peers who are not cancer survivors. Trying to establish a healthier lifestyle at a relatively young age helps these individuals to set certain lifestyle preferences when they are older. – by Jennifer Southall

Reference:

Mendoza JA, et al. Pediatr Blood Cancer. 2017;doi:10.1002/pbc.26660.

For more information:

Eric J. Chow, MD, MP H, can be reached at Seattle Children’s Hospital, 4800 Sand Point Way NE, Seattle, WA 98105; email: ericchow@uw.edu.

Disclosure: Chow reports no relevant financial disclosures.