Feasibility and Acceptability of a Physical Activity Tracker and Text Messages to Promote Physical Activity During Chemotherapy for Colorectal Cancer: Pilot Randomized Controlled Trial (Smart Pace II)

Erin L Van Blarigan, Anand Dhruva, Chloe E Atreya, Stacey A Kenfield, June M Chan, Alexandra Milloy, Iris Kim, Paige Steiding, Angela Laffan, Li Zhang, Sorbarikor Piawah, Yoshimi Fukuoka, Christine Miaskowski, Frederick M Hecht, Mi-Ok Kim, Alan P Venook, Katherine Van Loon, Erin L Van Blarigan, Anand Dhruva, Chloe E Atreya, Stacey A Kenfield, June M Chan, Alexandra Milloy, Iris Kim, Paige Steiding, Angela Laffan, Li Zhang, Sorbarikor Piawah, Yoshimi Fukuoka, Christine Miaskowski, Frederick M Hecht, Mi-Ok Kim, Alan P Venook, Katherine Van Loon

Abstract

Background: We conducted a pilot 2-arm randomized controlled trial to assess the feasibility of a digital health intervention to increase moderate-to-vigorous physical activity in patients with colorectal cancer (CRC) during chemotherapy.

Objective: This study aimed to determine whether a digital health physical activity intervention is feasible and acceptable during chemotherapy for CRC.

Methods: Potentially eligible patients with CRC expected to receive at least 12 weeks of chemotherapy were identified in person at the University of California, San Francisco, and on the web through advertising. Eligible patients were randomized 1:1 to a 12-week intervention (Fitbit Flex, automated SMS text messages) versus usual care. At 0 and 12 weeks, patients wore an Actigraph GT3X+ accelerometer for 7 days and completed surveys, body size measurements, and an optional 6-minute walk test. Participants could not be masked to their intervention arm, but people assessing the body size and 6-minute walk test outcomes were masked. The primary outcomes were adherence (eg, Fitbit wear and text response rate) and self-assessed acceptability of the intervention. The intervention would be considered feasible if we observed at least 80% complete follow-up and 70% adherence and satisfaction, a priori.

Results: From 2018 to 2020, we screened 240 patients; 53.3% (128/240) of patients were ineligible and 26.7% (64/240) declined to participate. A total of 44 patients (44/240, 18%) were randomized to the intervention (n=22) or control (n=22) groups. Of these, 57% (25/44) were women; 68% (30/44) identified as White and 25% (11/44) identified as Asian American or Pacific Islander; and 77% (34/44) had a 4-year college degree. The median age at enrollment was 54 years (IQR 45-62 years). Follow-up at 12 weeks was 91% (40/44) complete. In the intervention arm, patients wore Fitbit devices on a median of 67 out of 84 (80%) study days and responded to a median of 17 out of 27 (63%) questions sent via SMS text message. Among 19 out of 22 (86%) intervention patients who completed the feedback survey, 89% (17/19) were satisfied with the Fitbit device; 63% (12/19) were satisfied with the SMS text messages; 68% (13/19) said the SMS text messages motivated them to exercise; 74% (14/19) said the frequency of SMS text messages (1-3 days) was ideal; and 79% (15/19) said that receiving SMS text messages in the morning and evening was ideal.

Conclusions: This pilot study demonstrated that many people receiving chemotherapy for CRC are interested in participating in digital health physical activity interventions. Fitbit adherence was high; however, participants indicated a desire for more tailored SMS text message content. Studies with more socioeconomically diverse patients with CRC are required.

Trial registration: ClinicalTrials.gov NCT03524716; https://ichgcp.net/clinical-trials-registry/NCT03524716.

Keywords: SMS; colon cancer; digital health; exercise; rectal cancer; treatment; wearables.

Conflict of interest statement

Conflicts of Interest: None declared.

©Erin L Van Blarigan, Anand Dhruva, Chloe E Atreya, Stacey A Kenfield, June M Chan, Alexandra Milloy, Iris Kim, Paige Steiding, Angela Laffan, Li Zhang, Sorbarikor Piawah, Yoshimi Fukuoka, Christine Miaskowski, Frederick M Hecht, Mi-Ok Kim, Alan P Venook, Katherine Van Loon. Originally published in JMIR Cancer (https://cancer.jmir.org), 11.01.2022.

Figures

Figure 1
Figure 1
CONSORT (Consolidated Standards of Reporting Trials) flow diagram for the Smart Pace II study, a randomized controlled pilot study evaluating a 12-week physical activity intervention for people receiving chemotherapy for colon or rectal cancer. Stay Home Public Orders were enacted on March 17, 2020, in San Francisco, California, and all elective medical visits were cancelled, including two baseline and five 12-week 6-minute walk tests. ECOG: Eastern Cooperative Oncology Group; MD: medical doctor.
Figure 2
Figure 2
Number of participants in the intervention arm of the Smart Pace II pilot study who recorded at least 1500 steps per day on the Fitbit, by study day (n=22).
Figure 3
Figure 3
Number of participants in the intervention arm who responded to the SMS text messages that asked for a reply in the Smart Pace II pilot study (n=22).

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