Healthc Inform Res.  2023 Oct;29(4):352-366. 10.4258/hir.2023.29.4.352.

Effects of Digital Physical Activity Interventions for Breast Cancer Patients and Survivors: A Systematic Review and Meta-Analysis

• Kang H
• Moon M

• KMID: 2547688
• DOI: http://doi.org/10.4258/hir.2023.29.4.352

Abstract

Objectives
The benefits of physical activity (PA) for breast cancer (BC) patients and survivors are well documented. With the widespread use of the internet and mobile phones, along with the recent coronavirus disease 2019 pandemic, there has been a growing interest in digital health interventions. This study conducted a systematic review and meta-analysis to evaluate the effects of digital PA interventions for BC patients and survivors in improving PA and quality of life (QoL).
Methods
We searched eight databases, including PubMed, CINAHL, Embase, Scopus, Web of Science, Cochrane Central Register of Controlled Trials in the Cochrane Library, RISS, and DBpia. Studies were included if they provided digital PA interventions, assessed PA and QoL among BC patients and survivors, and were published from inception to December 31, 2022.
Results
In total, 18 studies were identified. The meta-analysis showed significant improvement in the total PA duration (five studies; standardized mean difference [SMD] = 0.71; 95% confidence interval [CI], 0.25–1.18; I² = 86.64%), functional capacity (three studies; SMD = 0.38; 95% CI, 0.10–0.66; I² = 14.36%), and QoL (nine studies; SMD = 0.45; 95% CI, 0.22–0.69; I² = 65.55%).
Conclusions
Digital PA interventions for BC patients and survivors may significantly improve PA, functional capacity, and QoL. Future research should focus on the long-term effects of digital PA interventions, using objective outcome measures.

Keyword

Breast Neoplasms, Digital Technology, Exercise, Meta-Analysis, Systematic Review

Figure

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  Figure 1 Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) diagram. PA: physical activity, RCT: randomized controlled trial.

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  Figure 2 Forest plots of the effects of digital physical activity (PA) interventions: (A) PA duration, (B) subgroup analysis for PA duration, (c) functional capacity, and (D) quality of life.

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  Figure 3 Risk of bias graph for included randomized controlled trials.

Reference

References

1. Spei ME, Samoli E, Bravi F, La Vecchia C, Bamia C, Benetou V.Physical activity in breast cancer survivors: A systematic review and meta-analysis on overall and breast cancer survival. Breast. 2019; 44:144–52. https://doi.org/10.1016/j.breast.2019.02.001.

2. Abdin S, Lavallee JF, Faulkner J, Husted M.A systematic review of the effectiveness of physical activity interventions in adults with breast cancer by physical activity type and mode of participation. Psychooncology. 2019; 28(7):1381–93. https://doi.org/10.1002/pon.5101.

3. Gokal K, Wallis D, Ahmed S, Boiangiu I, Kancherla K, Munir F.Effects of a self-managed home-based walking intervention on psychosocial health outcomes for breast cancer patients receiving chemotherapy: a randomised controlled trial. Support Care Cancer. 2016; 24(3):1139–66. https://doi.org/10.1007/s00520-015-2884-5.

4. Ekeland AG, Bowes A, Flottorp S.Effectiveness of telemedicine: a systematic review of reviews. Int J Med Inform. 2010; 79(11):736–71. https://doi.org/10.1016/j.ijmedinf.2010.08.006.

5. Roberts AL, Fisher A, Smith L, Heinrich M, Potts HWW.Digital health behaviour change interventions targeting physical activity and diet in cancer survivors: a systematic review and meta-analysis. J Cancer Surviv. 2017; 11(6):704–19. https://doi.org/10.1007/s11764-017-0632-1.

6. Murray E, Hekler EB, Andersson G, Collins LM, Doherty A, Hollis C, et al. Evaluating digital health interventions: key questions and approaches. Am J Prev Med. 2016; 51(5):843–51. https://doi.org/10.1016/j.amepre.2016.06.008.

7. Flores Mateo G, Granado-Font E, Ferre-Grau C, Montana-Carreras X.Mobile phone apps to promote weight loss and increase physical activity: a systematic review and meta-analysis. J Med Internet Res. 2015; 17(11):e253. https://doi.org/10.2196/jmir.4836.

8. Mistry N, Keepanasseril A, Wilczynski NL, Nieuwlaat R, Ravall M, Haynes RB, et al. Technology-mediated interventions for enhancing medication adherence. J Am Med Inform Assoc. 2015; 22(e1):e177–93. https://doi.org/10.1093/jamia/ocu047.

9. Pal K, Eastwood SV, Michie S, Farmer AJ, Barnard ML, Peacock R, et al. Computer-based diabetes self-management interventions for adults with type 2 diabetes mellitus. Cochrane Database Syst Rev. 2013; 2013(3):CD008776. https://doi.org/10.1002/14651858.CD008776.pub2.

10. Kaltenthaler E, Parry G, Beverley C, Ferriter M.Computerised cognitive-behavioural therapy for depression: systematic review. Br J Psychiatry. 2008; 193(3):181–4. https://doi.org/10.1192/bjp.bp.106.025981.

11. Singleton AC, Raeside R, Hyun KK, Partridge SR, Di Tanna GL, Hafiz N, et al. Electronic health interventions for patients with breast cancer: systematic review and meta-analyses. J Clin Oncol. 2022; 40(20):2257–70. https://doi.org/10.1200/JCO.21.01171.

12. Arem H, Sorkin M, Cartmel B, Fiellin M, Capozza S, Harrigan M, et al. Exercise adherence in a randomized trial of exercise on aromatase inhibitor arthralgias in breast cancer survivors: the Hormones and Physical Exercise (HOPE) study. J Cancer Surviv. 2016; 10(4):654–62. https://doi.org/10.1007/s11764-015-0511-6.

13. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. Updating guidance for reporting systematic reviews: development of the PRISMA 2020 statement. J Clin Epidemiol. 2021; 134:103–12. https://doi.org/10.1016/j.jclinepi.2021.02.003.

14. Higgins JP, Sterne JA, Savovic J, Page MJ, Hrobjartsson A, Boutron I, et al. A revised tool for assessing risk of bias in randomized trials. Cochrane Database Syst Rev. 2016; 10(Suppl 1):29–31.

15. Craig CL, Marshall AL, Sjostrom M, Bauman AE, Booth ML, Ainsworth BE, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003; 35(8):1381–95. https://doi.org/10.1249/01.MSS.0000078924.61453.FB.

16. Blair SN. How to assess exercise habits and physical fitness. Matarazzo JD, editor. Behavioral health: a handbook of health enhancement and disease prevention. New York (NY): Wiley;1984. p. 424–47.

17. Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993; 85(5):365–76. https://doi.org/10.1093/jnci/85.5.365.

18. Sprangers MA, Groenvold M, Arraras JI, Franklin J, te Velde A, Muller M, et al. The European Organization for Research and Treatment of Cancer breast cancer-specific quality-of-life questionnaire module: first results from a three-country field study. J Clin Oncol. 1996; 14(10):2756–68. https://doi.org/10.1200/JCO.1996.14.10.2756.

19. Brady MJ, Cella DF, Mo F, Bonomi AE, Tulsky DS, Lloyd SR, et al. Reliability and validity of the Functional Assessment of Cancer Therapy-Breast quality-of-life instrument. J Clin Oncol. 1997; 15(3):974–86. https://doi.org/10.1200/JCO.1997.15.3.974.

20. Fallowfield LJ, Leaity SK, Howell A, Benson S, Cella D.Assessment of quality of life in women undergoing hormonal therapy for breast cancer: validation of an endocrine symptom subscale for the FACT-B. Breast Cancer Res Treat. 1999; 55(2):189–99. https://doi.org/10.1023/a:1006263818115.

21. Skevington SM, Lotfy M, O’Connell KA; WHOQOL Group. The World Health Organization’s WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. a report from the WHOQOL group. Qual Life Res. 2004; 13(2):299–310. https://doi.org/10.1023/B:QURE.0000018486.91360.00.

22. Ware JE, Kosinski M, Keller SD. SF-36 physical and mental health summary scales: a users’ manual. Boston (MA): The Health Institute, New England Medical Center;1994.

23. Hays RD, Bjorner JB, Revicki DA, Spritzer KL, Cella D.Development of physical and mental health summary scores from the patient-reported outcomes measurement information system (PROMIS) global items. Qual Life Res. 2009; 18(7):873–80. https://doi.org/10.1007/s11136-009-9496-9.

24. Prochaska JO, Velicer WF.The transtheoretical model of health behavior change. Am J Health Promot. 1997; 12(1):38–48. https://doi.org/10.4278/0890-1171-12.1.38.

25. Soeken KL, Sripusanapan A.Assessing publication bias in meta-analysis. Nurs Res. 2003; 52(1):57–60. https://doi.org/10.1097/00006199-200301000-00009.

26. Beaudry RI, Liang Y, Boyton ST, Tucker WJ, Brothers RM, Daniel KM, et al. Meta-analysis of exercise training on vascular endothelial function in cancer survivors. Integr Cancer Ther. 2018; 17(2):192–9. https://doi.org/10.1177/1534735418756193.

27. Arena R, Myers J, Williams MA, Gulati M, Kligfield P, Balady GJ, et al. Assessment of functional capacity in clinical and research settings: a scientific statement from the American Heart Association Committee on Exercise, Rehabilitation, and Prevention of the Council on Clinical Cardiology and the Council on Cardiovascular Nursing. Circulation. 2007; 116(3):329–43. https://doi.org/10.1161/CIRCULATIONAHA.106.184461.

28. But-Hadzic J, Dervisevic M, Karpljuk D, Videmsek M, Dervisevic E, Paravlic A, et al. Six-minute walk distance in breast cancer survivors: a systematic review with meta-analysis. Int J Environ Res Public Health. 2021; 18(5):2591. https://doi.org/10.3390/ijerph18052591.

29. Kabore SS, Ngangue P, Soubeiga D, Barro A, Pilabre AH, Bationo N, et al. Barriers and facilitators for the sustainability of digital health interventions in low and middle-income countries: a systematic review. Front Digit Health. 2022; 4:1014375. https://doi.org/10.3389/fdgth.2022.1014375.

30. Melsen WG, Bootsma MC, Rovers MM, Bonten MJ.The effects of clinical and statistical heterogeneity on the predictive values of results from meta-analyses. Clin Microbiol Infect. 2014; 20(2):123–9. https://doi.org/10.1111/1469-0691.12494.