Background: As the number of cancer survivors increases, maintaining health-related quality of life in cancer survivorship is a priority. This necessitates accurate and reliable methods to assess how cancer survivors are feeling and functioning. Real-world digital measures derived from wearable sensors offer potential for monitoring well-being and physical function in cancer survivorship, but questions surrounding the clinical utility of these measures remain to be answered. Objective: In this secondary analysis, we used 2 existing data sets to examine how measures of real-world physical behavior, captured with a wearable accelerometer, were related to aerobic fitness and self-reported well-being and physical function in a sample of individuals who had completed cancer treatment. Methods: Overall, 86 disease-free cancer survivors aged 21-85 years completed self-report assessments of well-being and physical function, as well as a submaximal exercise test that was used to estimate their aerobic fitness, quantified as predicted submaximal oxygen uptake (VO2). A thigh-worn accelerometer was used to monitor participants’ real-world physical behavior for 7 days. Accelerometry data were used to calculate average values of the following measures of physical behavior: sedentary time, step counts, time in light and moderate to vigorous physical activity, time and weighted median cadence in stepping bouts over 1 minute, and peak 30-second cadence. Results: Spearman correlation analyses indicated that 6 (86%) of the 7 accelerometry-derived measures of real-world physical behavior were not significantly correlated with Functional Assessment of Cancer Therapy-General total well-being or linked Patient-Reported Outcomes Measurement Information System-Physical Function scores (Ps≥.08). In contrast, all but one of the physical behavior measures were significantly correlated with submaximal VO2 (Ps≤.03). Comparing these associations using likelihood ratio tests, we found that step counts, time in stepping bouts over 1 minute, and time in moderate to vigorous activity were more strongly associated with submaximal VO2 than with self-reported well-being or physical function (Ps≤.03). In contrast, cadence in stepping bouts over 1 minute and peak 30-second cadence were not more associated with submaximal VO2 than with the self-reported measures (Ps≥.08). Conclusions: In a sample of disease-free cancer survivors, we found that several measures of real-world physical behavior were more associated with aerobic fitness than with self-reported well-being and physical function. These results highlight the possibility that in individuals who have completed cancer treatment, measures of real-world physical behavior may provide additional information compared with self-reported and performance measures. To advance the appropriate use of digital measures in oncology clinical research, further research evaluating the clinical utility of real-world physical behavior over time in large, representative samples of cancer survivors is warranted. Trial Registration: ClinicalTrials.gov NCT03781154; https://clinicaltrials.gov/ct2/show/NCT03781154

Physical activity (PA) after a colorectal cancer (CRC) diagnosis can improve physical function and quality of life and is associated with decreased mortality rates and longer disease-free survival. The accelerated use of videoconference technology during and following the COVID-19 pandemic offers an opportunity to explore the potential of a virtually supervised intervention to help survivors of CRC increase PA. A two-arm single blind pilot randomized controlled trial of individuals who had completed treatment for CRC within the previous five-years (NCT03781154, 12/19/2018). The 12-week intervention consisted of circuit-based, combined aerobic and resistance exercise, twice per week for approximately one-hour per session, and five social cognitive theory-based PA behavior change discussion sessions. All intervention components were delivered in real-time via Zoom. Feasibility and acceptability were assessed, and the effects of the intervention were explored for the outcomes of PA (activPAL™ accelerometers and self-report), social cognitive theory constructs (barriers self-efficacy and outcome expectations), and physical fitness (submaximal aerobic capacity, upper and lower body muscular strength and endurance). Twenty-nine eligible individuals (55.2% women, Mean = 61 ± 11 years old, Mean = 22.0 ± 15.1 months since diagnosis) were randomized to the videoconference PA intervention (n = 15) or a PA education control (n = 14). A total of N = 25 completed the study for a retention rate of 86.7% in the intervention arm and 85.7% in the control. Adherence to intervention components was >86%. The intervention was highly acceptable with ≥90% responding “yes” or “definitely yes” that they enjoyed participating. Trends suggested that intervention participants had greater improvements in accelerometer measured steps per day, daily minutes of light PA, sedentary time, and aerobic fitness. There was no change in social cognitive theory constructs, and muscular strength and endurance improved in both the intervention and control. A 12-week videoconference PA intervention was feasible and acceptable among survivors of CRC, and the greatest magnitude of difference for intervention effects was observed for light PA and sedentary time. A fully powered trial is needed to determine efficacy of the intervention for increasing PA and physical functioning.

Purpose: High cancer-related fatigue (CRF) and low energy are commonly reported by survivors of cancer both during and following treatment(s) and can be alleviated by regular exercise. However, the immediate or “acute” effects of exercise for improving CRF and energy among survivors of cancer is not well understood. This study examined changes in CRF and energy from immediately before to immediately after exercise sessions during an 8-week videoconference exercise program. Methods: Videoconference exercise sessions were held 1× per week and consisted of light to moderate intensity aerobic and resistance exercise. Energy and CRF were self-reported immediately before and after each exercise session using a visual analog scale (0 = low, 10 = high). Separate linear mixed models were used for CRF and energy, with time (pre/post), treatment status (ie, receiving chemotherapy at the time of the program) and time × treatment interaction included as fixed effects. Results: Participants (N = 55) were M = 59 ± 9.94 years old, 96% female, with ovarian (61.8%), breast (30%), or other (7.2%) cancer, and 27% were receiving chemotherapy. There was a main effect of time for CRF [F(1, 380) = 18.96, P < .01; MΔ = − 0.63 ± −0.04], and for energy [F(1,380) = 93.91, P < .01; MΔ = 1.16 ± .001], but no effect of treatment status. Conclusion: Regardless of treatment status, CRF and energy improved from immediately before to after exercise sessions during an 8-week videoconference exercise program. Future research is needed to determine how to leverage the positive, acute effects of exercise to enhance exercise motivation and adherence, and to understand how exercise intensity may impact CRF and energy immediately following exercise.

Cancer‐related fatigue (CRF) is one of the most common and distressing symptoms experienced by cancer survivors. While exercise interventions have shown efficacy in reducing CRF, the acute effect of exercise on CRF is not well understood. In this state‐of‐the‐art review, we first provided historical context for the potential for exercise to provide immediate relief of CRF by summarizing plausible physiological and psychological mechanisms, then reviewed studies that have been done to date examining the acute effects of exercise on CRF, and finally, suggested directions for future research.

Background: Independent exercise beyond supervised sessions can help program participants achieve recommended exercise levels and contribute to health benefits. However, independent exercise is rarely reported, making it unclear how much program effects may be attributed to the supervised sessions. The aim of this study was to describe independent exercise during a videoconference-delivered exercise program for cancer survivors. Methods: Cancer survivors (N = 46) completed an 8-week program that included videoconference-delivered (i.e., Zoom) exercise sessions once per week and three behavior change discussions. Each week, participants reported frequency, duration, intensity, type, and context (e.g., where, type, with whom) of independent aerobic and resistance exercise. Results: Participants (mean ± SD age = 59 ± 10 years; 96% female) had been diagnosed with either ovarian (61%), breast (30%), colorectal (4%), or other (4%) types of cancer. Days per week of independent exercise were 2.7 ± 2.7 for light, 2.8 ± 2.2 for moderate, and 0.67 ± 1.3 for vigorous aerobic exercise. For resistance exercise the days per week performed was 1.3 ± 1.5. Median weekly independent minutes were 60 (range: 0–120) for light aerobic, 120 (range: 36–270) for moderate-to-vigorous aerobic, and 30 (range: 0–60) for resistance exercise. Independent exercise performed was most frequently brisk walking or weightlifting at home or in the neighborhood and with a spouse/partner, other family, or friends. Conclusion: Most participants engaged in substantial independent exercise outside of the supervised sessions. These findings provide detailed contextual information regarding independent exercise during an 8-week program and have implications for interpreting program effectiveness.

BACKGROUND As the number of cancer survivors increases, maintaining health-related quality of life in cancer survivorship is a priority. This necessitates accurate and reliable methods to assess how cancer survivors are feeling and functioning. Real-world digital measures derived from wearable sensors offer potential for monitoring well-being and physical function in cancer survivorship, but questions surrounding the clinical utility of these measures remain to be answered. OBJECTIVE In this secondary analysis, we used 2 existing data sets to examine how measures of real-world physical behavior, captured with a wearable accelerometer, were related to aerobic fitness and self-reported well-being and physical function in a sample of individuals who had completed cancer treatment. METHODS Overall, 86 disease-free cancer survivors aged 21-85 years completed self-report assessments of well-being and physical function, as well as a submaximal exercise test that was used to estimate their aerobic fitness, quantified as predicted submaximal oxygen uptake (VO2). A thigh-worn accelerometer was used to monitor participants’ real-world physical behavior for 7 days. Accelerometry data were used to calculate average values of the following measures of physical behavior: sedentary time, step counts, time in light and moderate to vigorous physical activity, time and weighted median cadence in stepping bouts over 1 minute, and peak 30-second cadence. RESULTS Spearman correlation analyses indicated that 6 (86%) of the 7 accelerometry-derived measures of real-world physical behavior were not significantly correlated with Functional Assessment of Cancer Therapy-General total well-being or linked Patient-Reported Outcomes Measurement Information System-Physical Function scores (Ps≥.08). In contrast, all but one of the physical behavior measures were significantly correlated with submaximal VO2 (Ps≤.03). Comparing these associations using likelihood ratio tests, we found that step counts, time in stepping bouts over 1 minute, and time in moderate to vigorous activity were more strongly associated with submaximal VO2 than with self-reported well-being or physical function (Ps≤.03). In contrast, cadence in stepping bouts over 1 minute and peak 30-second cadence were not more associated with submaximal VO2 than with the self-reported measures (Ps≥.08). CONCLUSIONS In a sample of disease-free cancer survivors, we found that several measures of real-world physical behavior were more associated with aerobic fitness than with self-reported well-being and physical function. These results highlight the possibility that in individuals who have completed cancer treatment, measures of real-world physical behavior may provide additional information compared with self-reported and performance measures. To advance the appropriate use of digital measures in oncology clinical research, further research evaluating the clinical utility of real-world physical behavior over time in large, representative samples of cancer survivors is warranted. CLINICALTRIAL ClinicalTrials.gov NCT03781154; https://clinicaltrials.gov/ct2/show/NCT03781154