Abstract
Physical activity (PA) enhancement and mental distress reduction are important issues in cancer survivorship care. Mobile technology, as an emerging method for changing health behaviors, is gaining attention from many researchers. This study aimed to investigate the effect of a mobile app-based community on enhancing PA and decreasing distress in breast cancer survivors. We conducted a non-randomized, prospective, interventional study that had a mobile community-later arm and mobile community-first arm. With an Android smartphone app (WalkON®), daily walk steps and weekly distress scores using app-based Distress Thermometer (DT) questionnaires were collected from participants for about 12 weeks. To examine the difference in weekly step counts before and during the community activity, we used a paired t-test method. For a comparative analysis, we referred to a previous prospective observational study without a mobile community intervention that had the same setting as the present study. After propensity score matching (PSM), multivariable regression modeling with difference-in-difference (DID) was performed to estimate the effect of the mobile app-based community on PA and mental distress. From January to August 2018, a total of 64 participants were enrolled in this study. In the univariate analysis, after participation in the mobile community, the participants showed a significant increase in total weekly steps (t = −3.5341; P = 0.00208). The mean of the differences was 10,408.72 steps. In the multivariate analysis after PSM, the mobile community significantly increased steps by 8,683.4 per week (p value <0.0001) and decreased DT scores by 0.77 per week (p value = 0.009) in the mixed effect model. In the two-way fixed effect model, the mobile community showed a significant increase in weekly steps by 8,723.4 (p value <0.0001) and decrease in weekly DT by 0.73 (p value = 0.013). The mobile app-based community is an effective and less resource-intensive tool to increase PA and decrease distress in breast cancer survivors.Trial Registration: NCT03190720, NCT03072966
Highlights
Many cancer survivors experience psychological distress after cancer diagnosis
The present study aimed to investigate the effects of a mobile app-based community program on enhancing physical activity (PA), and assess whether the mobile community program decreases mental distress through increasing PA in breast cancer survivors
Our results indicated that the selected mobile app-based community was effective to increase PA and decrease mental distress in breast cancer survivors
Summary
Many cancer survivors experience psychological distress after cancer diagnosis. Depression and anxiety have a prevalence of 11.6 and 17.9%, respectively, among cancer survivors [1]. A systematic review reported 22 and 10%, respectively, as the prevalence of depression and anxiety among breast cancer survivors [2]. Pharmacologic and/or non-pharmacologic interventions can be used to manage depressive symptoms in cancer survivors [4]. Exercise is one of the important non-pharmacologic interventions for mental distress in breast cancer survivors. Many breast cancer survivors are not physically active, which is generally associated with poorer health-related quality of life (HRQOL) [5]. Interventions to enhance physical activity (PA) may improve mental HRQOL in breast cancer survivors who have completed cancer therapy. The Breast Cancer Survivorship Care Guidelines from the American Cancer Society and American Society of Clinical Oncology recommend that breast cancer survivors avoid inactivity and do at least 150 min of moderate or 75 min of vigorous aerobic exercise every week [6]
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