Fitness Apps Could Help Cancer Survivors Become More Active

Rubén Martín Payo, PhD

About 20% of fitness apps reviewed in a recent study were deemed appropriate for survivors of cancer, showing that they could be an effective tool in helping this population increase physical activity. Investigators from the University of Surrey in the United Kingdom and Spain’s Universidad de Oviedo said that, based on these data, physicians could recommend such apps to their patients.¹

Lead author Rubén Martín Payo, PhD; along with coauthors Jenny Harris, MSc, and Jo Armes, PhD; evaluated 67 free fitness apps available for iOS and Android for their suitability for use by patients recovering from cancer and their ability to improve physical activity for these survivors. They did not recommend specific apps but concluded that roughly one-fifth of the fitness apps examined included information suitable for people affected by cancer, suggesting that such programs could be an effective tool in helping patients and survivors improve physical activity.

“We think that it’s difficult to say what’s the best app or what’s the ideal app,” Armes, a reader in cancer care and lead for digital health at the University of Surrey, said in an e-mail. “As we concluded, apps should be selected based on the needs and preferences of the individual. Specifically, people affected by cancer have some needs that people without the illness don’t have.”

The apps most successful at inducing change in health-related behaviors focused on aerobic-based activities and tended to include goal setting, monitoring, and feedback.

“Clinicians are often hesitant to recommend fitness apps to help cancer survivors increase physical activity levels, as they are unsure of the quality and suitability of the information provided,” Harris, a research fellow at the School of Health Sciences at the University of Surrey, said in a news release. “Our ongoing research in this area has found that there are suitable fitness apps to help increase activity levels, and this will help equip clinicians with the knowledge and confidence in prescribing them, helping patients to benefit from the positive impact of physical activity.”

Guidelines issued by the American Cancer Society (ACS) in 2012 advise “healthy weight management, a healthful diet, and a physically active lifestyle” for long-term survivors to prevent recurrence, second primary cancers, and other chronic diseases.² The US Department of Health and Human Services recommends that adults with chronic conditions or disabilities, including cancer, should do 150 to 300 minutes a week of moderate-intensity physical activity or 75 to 150 minutes a week of vigorous-intensity aerobic physical activity.³

Unfortunately, survivors aren’t always diligent about sticking with an exercise regimen. Investigators in the Yale Fitness Trial assessed adherence to the ACS guidelines among female cancer survivors who participated in an exercise intervention trial for 1 year. In data published in May 2019, Park et al found that adherence was only moderate even among “highly motivated” survivors. Physical activity levels improved among participants, but there was no significant change in adherence to weight, dietary, or alcohol intake guidelines.⁴

The investigators said that fewer than 25% of cancer survivors meet physical activity guidelines. Not only will physical activity help improve the quality of life of survivors, it lessens their risk of developing new conditions, such as osteoporosis or diabetes, they added.

Debra Patt, MD, MPH, MBA, a breast cancer specialist and executive vice president at Texas Oncology, discussed the effect that obesity has on patients with cancer with Evidence-Based Oncology^™, an indexed publication of the American Journal of Managed Care, in October 2019. Excess weight can reduce the effectiveness of some therapies, she said, and clinicians need to encourage patients to eat healthy food and exercise to both improve outcomes and prevent recurrence.⁵

“For many patients who undergo surgery for the treatment of cancer, recovery is much faster if they [exercise] and their cardiovascular health [improves],” she said. “What we see here is that diet, exercise, and physical fitness can influence cancer outcomes in many ways.”

There are limited real-world data available suggesting how patients can adhere with the fitness guidelines, and Payo, Armes, and Harris hypothesized that smartphone fitness apps could serve as a virtual exercise trainer to keep patients motivated and adherent. By providing clinical data, the authors hoped that oncologists would feel comfortable recommending these apps to their patients. Apps that required payment, those that required the use of wearable technologies, and apps with inappropriate content, such as negative body images, and/or unfounded claims of efficacy, were excluded.

The investigative team rated the apps using the Mobile App Rating Scale (MARS), which evaluates factors like engagement, functionality, aesthetics, and information, as well considerations such as awareness and knowledge. The apps were also assessed for behavior change techniques, such as goal setting and monitoring. Each factor was rated on a 5-point scale, with 5 meaning “excellent” and 1 meaning “inadequate.”

More than half the apps were available on both iOS and Android. Forty-six percent focused on a combination of aerobic/strength training or stretching, while 39% provided only aerobic training.

Compared with Android apps, the investigators found that iOS apps were more likely to try to change users’ attitudes toward improving their health. iOS apps were also better at encouraging users to seek further help to address changing attitudes toward improving health and performed slightly better in terms of content and quality.

“Our findings contribute to helping physicians and other health professionals to understand that apps are potential options to assist patients to increase their physical activity but not all the apps can be recommended for them,” Armes said. “In any case, more research and evidence are needed as this was a preliminary study.”

She added that the research team is working develop tools that effectively help health professionals and patients to choose physical activity apps. “Additionally, it is necessary to highlight the constantly changing nature of the apps markets, which requires regular re-evaluation of research findings,” she added.

References

1. Payo RM, Harris J, Armes J. Prescribing fitness apps for people with cancer: a preliminary assessment of content and quality of commercially available apps. J Cancer Surviv. 2019;13(3):397-405. doi: 10.1007/s11764-019-00760-2.
2. Rock CL, Doyle C, Denmark-Wahnefried W, et al. Nutrition and physical activity guidelines for cancer survivors [erratum in CA Cancer J Clin. 2013;63(3):215]. CA Cancer J Clin. 2012; 62(4):242-274. doi: 10.3322/caac.21142.
3. Department of Health and Human Services. Physical activity guidelines for Americans. HHS website. hhs.gov/fitness/be-active/physical-activity-guidelines-for-americans/index.html. Published February 1, 2019. Accessed October 29, 2019.
4. Park SH, Knobf MT, Kerstetter J, Jeon S. Adherence to American Cancer Society guidelines on nutrition and physical activity in female cancer survivors: results from a randomized controlled trial (Yale Fitness Intervention Trial). Cancer Nurs. 2019;42(3):242-250. doi: 10.1097/NCC.0000000000000602.
5. Patt D, Rosenberg J. How obesity affects cancer treatment—and how to talk with patients about prevention. Am J Manag Care. 2019;25(SP11)SP336-SP337.