Physical activity may be one way for teen cancer survivors to reduce their risk of several chronic conditions. A team led by researchers at Seattle Children’s recently tested the practicality of using a Fitbit Flex and Facebook to help encourage physical activity among survivors.

The battle against cancer continues well after remission for many adolescents and young adults. Cancer survivors are at increased risk to develop chronic diseases like obesity, type 2 diabetes, high blood pressure and second cancers.

Physical activity can be an important factor to help lower the risk of developing these conditions while providing an increased quality of life among survivors. However, many studies have shown that cancer survivors maintain a lower level of physical activity than their peers.

A team of researchers led by Dr. Jason Mendoza at Seattle Children’s Center for Child Health, Behavior and Development and Dr. Eric Chow at Seattle Children’s Cancer and Blood Disorders Center recently tested the feasibility of a mobile health intervention aimed at encouraging increased physical activity among teen cancer survivors. The team tapped into wearable fitness technology, the Fitbit Flex, social media and self-determination theory (SDT) to develop an approach that meets teen cancer survivors where they’re at.

“Teens are very connected and on mobile devices a lot,” Mendoza said. “We also know that people are more likely to practice a behavior, like exercise, when they are internally motivated to do so. This mobile health intervention was focused on tying those factors together to encourage physical activity.”

The results of the 10-week pilot study, published in the journal Pediatric Blood & Cancer, found the mobile health intervention is a practical approach teen cancer survivors are open to and warrants further randomized controlled trial studies. Participants wore the physical activity tracking device on more than 70% of days during the intervention period, more than 90% completed questionnaires, and interviews of participants affirmed that this was an acceptable intervention encouraging physical activity.

Incorporating everyday trends into survivorship

The study analyzed data from 59 14- to 18-year old cancer survivors. Twenty-nine participants were randomly chosen to wear a Fitbit Flex that tracked their physical activity, and they were also given access to a closed Facebook group where they were able to discuss their progress and support one another in increasing their physical activity. Participation with the Fitbit Flex and Facebook group was voluntary.

“The Fitbit gave participants a metric to chart their progress each day,” Mendoza said. “The Facebook group facilitated peer support to motivate participants.”

Seattle Children’s research staff served as health coaches, who called or texted with participants weekly to help set step goals and awarded cleverly-named achievement badges on Facebook.

“Kids don’t want to spend a lot of time talking to health professionals,” Mendoza said. “So the coaching was really about motivating, goal-setting and providing feedback on the physical activity data from the Fitbit.”

But SDT, which is premised on a person’s own psychological needs of competence, autonomy and connectedness to others serving as their main motivational factors, was the driving force behind the study.

“SDT is especially important as it relates to teens because they’re developing their independence and personal health habits that will shape their future,” Mendoza said. “We think this behavioral approach fits very well with this age group.”

Dr. Jason Mendoza is discussing follow-up studies that will focus on innovative ways to encourage increased physical activity among teen cancer survivors.

Facilitating survivorship with more research

Mendoza is already collaborating with researchers on the design of future studies that will likely address the initial feedback received from the study’s participants.

“The primary purposes of this study were not just to determine feasibility and acceptability, but to also collect ideas for improvement from participants,” Mendoza said.

The responses to qualitative interviews from participants ranged from high praise for the convenience of the Fitbit to suggestions for text message reminders and the use of social mediums popular among teens like Instagram and Snapchat.

“With more resources and shaping, this could be a very effective approach to a really important issue,” Mendoza said. “Most exercise programs take place in a hospital or clinic. This method is much more convenient for survivors and brings the next step of care to them.”

The study was supported by a Supportive Care Research Grant from St. Baldrick’s Foundation and the Adolescent and Young Adult Cancer Program at Seattle Children’s.

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