Feasibility and preliminary efficacy of an exercise telephone counseling intervention for hematologic cancer survivors: a phase II randomized controlled trial
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Supervised exercise interventions produce the largest improvements in patient-reported outcomes in cancer survivors but their scalability has been questioned. Telephone counseling has been proposed as a more feasible alternative but its impact on exercise behavior and health outcomes have been modest. Basing telephone counseling exercise (TCE) interventions on the theoretical advances described in the multi-process action control framework (M-PAC) may improve these outcomes.
To assess the feasibility and preliminary efficacy of a M-PAC-based TCE intervention for increasing aerobic exercise behavior in hematologic cancer survivors (HCS).
We recruited 51 HCS who were randomized to either a weekly TCE group (n = 26) or a self-directed exercise (SDE) group (n = 25). Participants completed online measures of self-reported aerobic exercise behavior, quality of life (QoL), fatigue, and program satisfaction at baseline and post-intervention (12 weeks).
Adherence to the TCE intervention was 93% and retention was 100%. Participants receiving TCE increased their weekly aerobic exercise by 218 min compared to 93 min in the SDE group [mean-adjusted between-group difference (MBGDadj) = 139, 95%CI = 65 to 213, p < .001, effect size (d) = 2.19]. Clinically meaningful QoL improvements favored the TCE group for mental health (MBGDadj = 3.7, 95%CI = − 0.4 to 7.9, p = .08, d = 0.42) and mental health component (MBGDadj = 3.6, 95%CI = − 0.8 to 8.1, p = .10, d = 0.35) subscales.
The 12-week TCE intervention substantially increased exercise behavior and may have meaningfully improved QoL in HCS.
Implications for Cancer Survivors
Though more definitive trials are needed, remote TCE interventions based on the M-PAC may improve exercise behavior and QoL in HCS and perhaps other cancer survivor groups.
Trial registration number
Clinical Trials ID: NCT03052777
KeywordsPhysical activity Leukemia Lymphoma M-PAC Exercise behavior
JRV is supported by the Frederick Banting and Charles Best Canada Graduate Scholarship through the Canadian Institutes of Health Research. RER is supported by a Canadian Cancer Society Senior Scientist Award and the Right to Give Foundation. KSC is supported by the Canada Research Chairs Program.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
- 2.Courneya KS, Sellar CM, Stevinson C, McNeely ML, Peddle CJ, Friedenreich CM, et al. Randomized controlled trial of the effects of aerobic exercise on physical functioning and quality of life in lymphoma patients. J Clin Oncol. 2009;27(27):4605–12. https://doi.org/10.1200/JCO.2008.20.0634.CrossRefPubMedGoogle Scholar
- 3.Courneya KS, Friedenreich CM, Franco-Villalobos C, Crawford JJ, Chua N, Basi S, et al. Effects of supervised exercise on progression-free survival in lymphoma patients: an exploratory follow-up of the HELP Trial. Cancer Causes Control. 2015;26(2):269–76. https://doi.org/10.1007/s10552-014-0508-x.CrossRefPubMedGoogle Scholar
- 7.Buffart LM, Kalter J, Sweegers MG, Courneya KS, Newton RU, Aaronson NK, et al. Effects and moderators of exercise on quality of life and physical function in patients with cancer: an individual patient data meta-analysis of 34 RCTs. Cancer Treat Rev. 2017;52:91–104. https://doi.org/10.1016/j.ctrv.2016.11.010.CrossRefPubMedGoogle Scholar
- 8.Richards J, Hillsdon M, Thorogood M, Foster C. Face-to-face interventions for promoting physical activity. Cochrane Database Syst Rev. 2013;(9). https://doi.org/10.1002/14651858.CD010392.pub2.
- 9.Sweegers MG, Altenburg TM, Chinapaw MJ, Kalter J, Verdonck-de Leeuw IM, Courneya KS, et al. Which exercise prescriptions improve quality of life and physical function in patients with cancer during and following treatment? A systematic review and meta-analysis of randomised controlled trials. Br J Sports Med. 2017:bjsports-2017-097891. https://doi.org/10.1136/bjsports-2017-097891.
- 10.Richards J, Thorogood M, Hillsdon M, Foster C. Face-to-face versus remote and web 2.0 interventions for promoting physical activity. Cochrane Database Syst Rev. 2013;(9). https://doi.org/10.1002/14651858.CD010393.pub2.
- 12.Bluethmann SM, Vernon SW, Gabriel KP, Murphy CC, Bartholomew LK. Taking the next step: a systematic review and meta-analysis of physical activity and behavior change interventions in recent post-treatment breast cancer survivors. Breast Cancer Res Treat. 2015;149(2):331–42. https://doi.org/10.1007/s10549-014-3255-5.CrossRefPubMedPubMedCentralGoogle Scholar
- 13.Kuijpers W, Groen WG, Aaronson NK, van Harten WH. A systematic review of web-based interventions for patient empowerment and physical activity in chronic diseases: relevance for cancer survivors. J Med Internet Res. 2013;15(2):e37. https://doi.org/10.2196/jmir.2281.CrossRefPubMedPubMedCentralGoogle Scholar
- 15.Rose T, Barker M, Maria Jacob C, Morrison L, Lawrence W, Strommer S, et al. A systematic review of digital interventions for improving the diet and physical activity behaviors of adolescents. J Adolesc Health. 2017;61(6):669–77. https://doi.org/10.1016/j.jadohealth.2017.05.024.CrossRefPubMedGoogle Scholar
- 17.O'Brien N, McDonald S, Araujo-Soares V, Lara J, Errington L, Godfrey A, et al. The features of interventions associated with long-term effectiveness of physical activity interventions in adults aged 55-70 years: a systematic review and meta-analysis. Health Psychol Rev. 2015;9(4):417–33. https://doi.org/10.1080/17437199.2015.1012177.CrossRefPubMedGoogle Scholar
- 19.Goode AD, Lawler SP, Brakenridge CL, Reeves MM, Eakin EG. Telephone, print, and web-based interventions for physical activity, diet, and weight control among cancer survivors: a systematic review. J Cancer Surviv. 2015;9(4):660–82. https://doi.org/10.1007/s11764-015-0442-2.CrossRefPubMedGoogle Scholar
- 28.Ligibel JA, Meyerhardt J, Pierce JP, Najita J, Shockro L, Campbell N, et al. Impact of a telephone-based physical activity intervention upon exercise behaviors and fitness in cancer survivors enrolled in a cooperative group setting. Breast Cancer Res Treat. 2012;132(1):205–13. https://doi.org/10.1007/s10549-011-1882-7.CrossRefPubMedGoogle Scholar
- 30.Hayes SC, Rye S, Disipio T, Yates P, Bashford J, Pyke C, et al. Exercise for health: a randomized, controlled trial evaluating the impact of a pragmatic, translational exercise intervention on the quality of life, function and treatment-related side effects following breast cancer. Breast Cancer Res Treat. 2013;137(1):175–86. https://doi.org/10.1007/s10549-012-2331-y.CrossRefPubMedGoogle Scholar
- 31.Hawkes AL, Pakenham KI, Chambers SK, Patrao TA, Courneya KS. Effects of a multiple health behavior change intervention for colorectal cancer survivors on psychosocial outcomes and quality of life: a randomized controlled trial. Ann Behav Med. 2014;48(3):359–70. https://doi.org/10.1007/s12160-014-9610-2.CrossRefPubMedGoogle Scholar
- 33.Belanger-Gravel A, Godin G, Vezina-Im LA, Amireault S, Poirier P. The effect of theory-based interventions on physical activity participation among overweight/obese individuals: a systematic review. Obes Rev. 2011;12(6):430–9. https://doi.org/10.1111/j.1467-789X.2010.00729.x.CrossRefPubMedGoogle Scholar
- 35.Stacey FG, James EL, Chapman K, Courneya KS, Lubans DR. A systematic review and meta-analysis of social cognitive theory-based physical activity and/or nutrition behavior change interventions for cancer survivors. J Cancer Surviv. 2015;9(2):305–38. https://doi.org/10.1007/s11764-014-0413-z.CrossRefPubMedGoogle Scholar
- 36.Hagger MS, Chatzisarantis NLD, Biddle SJH. A meta-analytic review of the theories of reasoned action and planned behavior in physical activity: predictive validity and the contribution of additional variables. J Sport Exerc Psychol. 2002;24(1):3–32. https://doi.org/10.1123/jsep.24.1.3.CrossRefGoogle Scholar
- 43.Tanna S, Arbour-Nicitopoulos KP, Rhodes RE, Bassett-Gunter R. A pilot study exploring the use of a telephone-assisted planning intervention to promote parental support for physical activity among children and youth with disabilities. Psychol Sport Exerc. 2017;32(Supplement C):25–33. https://doi.org/10.1016/j.psychsport.2017.05.003.CrossRefGoogle Scholar
- 50.Physiology CSfE. Canadian Physical Activity and Sedentary Behaviour Guidelines. 2012.Google Scholar
- 52.Courneya KS, Vardy JL, O'Callaghan CJ, Friedenreich CM, Campbell KL, Prapavessis H, et al. Effects of a structured exercise program on physical activity and fitness in colon cancer survivors: one year feasibility results from the CHALLENGE trial. Cancer Epidemiol Biomark Prev. 2016;25(6):969–77. https://doi.org/10.1158/1055-9965.EPI-15-1267.CrossRefGoogle Scholar
- 53.Courneya KS, Vardy J, Gill S, Jonker D, O’Brien P, Friedenreich CM, et al. Update on the colon health and life-long exercise change trial: a phase III study of the impact of an exercise program on disease-free survival in colon cancer survivors. Curr Colorectal Cancer Rep. 2014;10(3):321–8. https://doi.org/10.1007/s11888-014-0231-8.CrossRefGoogle Scholar
- 56.Amireault S, Godin G, Lacombe J, Sabiston CM. Validation of the Godin-Shephard leisure-time physical activity questionnaire classification coding system using accelerometer assessment among breast cancer survivors. J Cancer Surviv. 2015;9(3):532–40. https://doi.org/10.1007/s11764-015-0430-6.CrossRefPubMedGoogle Scholar
- 57.Ware J, Kosinski M, Bjorner J, Turner-Bowker D, Gandek B, Maruish M. User’s manual for the SF-36v2 Health Survey. Quality Metric; 2008.Google Scholar
- 62.Cella D, Eton DT, Lai JS, Peterman AH, Merkel DE. Combining anchor and distribution-based methods to derive minimal clinically important differences on the functional assessment of cancer therapy (FACT) anemia and fatigue scales. J Pain Symptom Manag. 2002;24(6):547–61. https://doi.org/10.1016/S0885-3924(02)00529-8.CrossRefGoogle Scholar
- 63.Nordin Å, Taft C, Lundgren-Nilsson Å, Dencker A. Minimal important differences for fatigue patient reported outcome measures—a systematic review. BMC Med Res Methodol. 2016;16(1) https://doi.org/10.1186/s12874-016-0167-6.
- 64.Hawkes AL, Chambers SK, Pakenham KI, Patrao TA, Baade PD, Lynch BM, et al. Effects of a telephone-delivered multiple health behavior change intervention (CanChange) on health and behavioral outcomes in survivors of colorectal cancer: a randomized controlled trial. J Clin Oncol. 2013;31(18):2313–21. https://doi.org/10.1200/JCO.2012.45.5873.CrossRefPubMedGoogle Scholar
- 68.Mazzoni AS, Nordin K, Berntsen S, Demmelmaier I, Igelstrom H. Comparison between logbook-reported and objectively-assessed physical activity and sedentary time in breast cancer patients: an agreement study. BMC Sports Sci Med Rehabil. 2017;9(1):8. https://doi.org/10.1186/s13102-017-0072-2.CrossRefPubMedPubMedCentralGoogle Scholar
- 71.Courneya KS, Mackey JR, Bell GJ, Jones LW, Field CJ, Fairey AS. Randomized controlled trial of exercise training in postmenopausal breast cancer survivors: cardiopulmonary and quality of life outcomes. J Clin Oncol. 2003;21(9):1660–8. https://doi.org/10.1200/JCO.2003.04.093.CrossRefPubMedGoogle Scholar