The number of cancer survivors, defined as individuals with cancer from diagnosis through death,1 has increased markedly in recent decades and will reach an estimated 18 million worldwide by 2022.2 Cancer survivors experience a wide range of physical and psychological symptoms due to their underlying malignancies and associated treatments.1,3,4 Exercise is a promising intervention to prevent and ameliorate cancer- and treatment-related toxicities.5 Prior studies,6–11 including a systematic review of 34 exercise interventions for patients with cancer during and after treatments,6 report that exercise in survivors improves strength, endurance, and cardiopulmonary function, thereby resulting in improved physical and mental health and health-related quality of life (HRQoL). Based on these benefits, efforts to integrate exercise interventions in cancer care are increasing.1,12 These interventions can be delivered in prescriptions that define exercise mode, duration, frequency, and intensity as part of routine cancer care.
Poor adherence to exercise interventions is a major barrier to achieving the optimal benefits of exercise.13–16 The presence of symptoms related to cancer and its treatments, including fatigue, depression, insomnia, and pain, may further hinder cancer survivors' exercise intervention adherence.13 Multiple studies suggest that self-efficacy is an independent predictor of exercise adherence in the general population17,18 and in patients with illnesses, including chronic obstructive pulmonary disease,19 obesity,20 congestive heart failure,21 stroke,22 type 2 diabetes mellitus,23 and cancer.24 There is, therefore, interest in identifying ways of increasing self-efficacy.
Exercise interventions using digital activity trackers (E-DATs), including digital healthcare-related wearable sensors, digital processing applications (apps), or communication equipment,25 may improve self-efficacy of cancer survivors, leading to higher adherence to exercise interventions.26 E-DATs can facilitate monitoring of exercise progress for cancer survivors in real time, providing them with virtual feedback to enhance motivation and address potential exercise barriers.26–28 Additional benefits of E-DATs include objective data collection, patient-tailored (or precision) interventions, and in some cases, ability to communicate virtually with healthcare providers regarding symptoms, exercise experience, or questions.
Use of E-DAT behavioral interventions is a rapidly expanding area of research and practice27–29 but has only recently been applied to cancer survivors.30,31 To improve understanding of this emerging field, we conducted a systematic review to summarize findings from randomized controlled trials (RCTs) of E-DATs in cancer survivors. The primary aim of this review was to evaluate retention and adherence rates to E-DATs. The secondary aim was to assess the effects of E-DATs on activity level, body composition, objective fitness outcomes, HRQoL, self-reported symptoms, and biomarker data.
The authors would like to acknowledge Daniel Castillo for his assistance in performing the literature search and Susan Rosenthal for her editorial assistance.
Disclosures: The authors have disclosed that they have not received any financial considerations from any person or organization to support the preparation, analysis, results, or discussion of this article.
Funding: This work was supported by the NCI, including funds from NCORP (UG1CA189961), NCORP supplement (U10CA037420), and R25CA102618.
Previous Presentation: This research was presented as a poster at the 2018 ASCO Cancer Survivorship Symposium; February 16–17, 2018; Orlando, Florida.
See JNCCN.org for supplemental online content.
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