Table 2.
Combination of mHealth intervention tools used in randomized controlled trials among cancer survivors to promote physical activity and/or dietary change, and associations with change in physical activity, diet, and/or quality of life, sorted by outcome measure.
| Author, Year | Sample Size | Website/Mobile App | Wearable Activity Tracker | Coaching | Text Message | Result | |
|---|---|---|---|---|---|---|---|
| Between-Group Difference | Within-Group Difference | ||||||
| Lifestyle score based on diet and physical activity | |||||||
| Chan et al., 2020 [23] | 202 | √ | √ | √ | √ | Significant between-group differences in mean lifestyle score change compared to level 1 were observed in levels 2 (mean change: 0.9, 95% CI: 0.4–1.4), 3 (mean change: 0.5, 95% CI: 0.02–1.0), and 4 (mean change: 1.1, 95% CI: 0.7–1.6) at 12 weeks | Not reported |
| Kenfield et al., 2019 [35] | 76 | √ | √ | √ | Improvements in four out of eight recommended behaviors were observed in the intervention arm. The estimated mean lifestyle score of the intervention arm was 1.5 (95% CI: 0.7–2.3) points higher than that of the control arm at 12 weeks (p < 0.001) | Median (IQR) absolute changes in the lifestyle score from the baseline to 12 weeks were 2 (1, 3) points in the intervention arm and 0 (1, 1) points in the control arm | |
| Physical activity | |||||||
| Chow et al., 2020 a [24] | 41 | √ | √ | √ | √ | No significant between-group difference in physical activity over time was observed | No significant within-group change was observed |
| Pinto et al., 2021 [22] | 20 | √ | √ | √ | Significant differences in the changes in step counts (Cohen’s effect size = 1.1, p = 0.02) and MVPA (Cohen’s effect size = 1.0, p = 0.04) favoring the audiobook group were observed from 0 to 12 weeks | Participants in the audiobook group on average added 1487.2 steps per day (Cohen’s effect size = 0.79, p = 0.11) and 71 min per week of MVPA (Cohen’s effect size = 0.8, p = 0.15) from 0 to 12 weeks | |
| Cadmus-Bertram et al., 2019 b [27] | 50 dyads | √ | √ | √ | Compared to the control group, survivors in the intervention group had a significant improvement in the MVPA minutes per week (effect size = 1.1, p < 0.01) and daily steps (effect size = 1.0, p < 0.01) at 12 weeks | Survivors in the intervention group increased their MVPA by 69 ± 84 min/week and daily steps by 1470 ± 1881. Survivors in the control group decreased their MVPA by 20 ± 71 min/week and daily steps by 398 ± 1751 | |
| Maxwell-Smith et al., 2019 [32] | 68 | √ | √ | √ | Improvement in minutes of MVPA per week (mean difference in change: 66 min/week, p = 0.03) in the intervention group compared to the control group at 12 weeks | Intervention group increased their MVPA by 45 min/week (95% CI: 2–88), while a reduction of 21 min/week (95% CI: −59–17) was observed for the control group | |
| Mayer et al., 2017 [42] | 284 | √ | √ | √ | No significant between-group difference in physical activity over time was observed | Not reported | |
| Valle et al., 2017 [43] a | 35 | √ | √ | √ | No differences between groups over time by way of a change in dietary intake or energy expenditure from physical activity at 3 months | A significant increase in energy expenditure from the baseline to 6 months was observed in the intervention group with the wearable activity tracker (median: 432, IQR: 706, p = 0.03) | |
| Van Blarigan et al., 2019 [38] | 42 | √ | √ | √ | No difference in the change in physical activity was found from the baseline to 12 weeks between arms | Not reported | |
| Ferrante et al., 2018 [39] a | 35 | √ | √ | √ | No between-group difference in physical activity was observed | No within-group change was observed | |
| Golsteijn et al., 2018 [41] | 478 | √ | √ | Participants in the intervention group improved their self-reported MVPA minutes per week (between-group change: 139, 95% CI: 9.4–269.0, p = 0.04) and days with at least 30 min of physical activity in a week (between-group change: 0.8, 95% CI: 0.5–1.1, p < 0.01) at 3 months, and ActiGraph assessed MVPA (between-group change: 45.9, 95% CI: 13.5–78.3, p < 0.01) at 6 months | Not reported | ||
| Rees-Punia et al., 2021 [21] | 85 | √ | No between-group difference in sedentary, light-intensity physical activity, MVPA, or self-reported strength training | Not reported | |||
| Ormel et al., 2018 [40] | 32 | √ | Significant median difference in change in self-reported physical activity score favoring the intervention group (median: 12.1, IQR: 105.1, p = 0.02) at 6 weeks | Not reported | |||
| Short et al., 2017 [44] | 492 | √ | No between-group difference in physical activity | Significant improvements in self-reported MVPA minutes were observed in the single-module group (mean change: 192.3, 95% CI: 139.9–244.8), weekly module group (mean change: 168.3, 95% CI: 116.8–219.9), and monthly module group (mean change: 173.9, 95% CI: 119.0–228.8) | |||
| Finlay et al., 2020 [29] | 71 | √ | No between-group differences in self-reported MVPA or resistance training | An increase across groups in the percentage of participants meeting the guidelines relative to the baseline scores (free choice +25%; tunneled +20%; control +36%). Within-group changes in MVPA in all groups were not statistically significant | |||
| Gell et al., 2019 [30] | 66 | √ | √ | √ | Difference in change in weekly MVPA minutes between groups (p = 0.03; effect size d = 0.6) observed at 8 weeks | Intervention group maintained their weekly MVPA minutes (mean change: 26.2, p = 0.35) while the control group had a significant decrease in their weekly MVPA minutes (mean change: −57.5, p = 0.03) | |
| McNeil et al., 2019 [36] | 45 | √ | √ | Increase in MVPA (between-group difference: 36, 95% CI: 6–60, p < 0.01) min/day and decrease in sedentary (between-group difference: −72, 95% CI: −132 to −12, p = 0.02) min/day were significantly greater in the lower-intensity physical activity group compared to the control group at 12 weeks. No significant differences were noted between the high-intensity physical activity and control groups | Adjusted mean increases in total (mean change: 42, 95% CI: 6–78, p = 0.02) min/day and MVPA (mean change: 24, 95% CI: 6–42, p = 0.01) min/day were observed in the high-intensity physical activity group | ||
| Gomersall et al., 2019 [34] | 36 | √ | √ | Compared to the standard group, the text message-enhanced group showed a significant improvement in self-reported MVPA at 4 weeks (between-group difference: 53.2 min/day, 95% CI: 2.9–103.5, p = 0.04). By 12 weeks, relative to the standard group, participants in the text message-enhanced group sat less (between-group difference: −80.1 min/day, 95% CI: −156 to −3.8, p = 0.04) and participated in more MVPA (between-group difference: 67.3 min/day, 95% CI: 24.0–110.6, p = 0.02) | Compared to the baseline, participants in the text message-enhanced group engaged in more vigorous physical activity (mean change: 19.6 min/day, 95% CI: 2.5–36.8), and participants in the standard clinic engaged in less MVPA (mean change: −50 min/day, 95% CI: −79.1 to −21.1, p < 0.01) | ||
| Diet | |||||||
| Chow et al., 2020 [24] a | 41 | √ | √ | √ | √ | No significant between-group difference over time observed | No significant within-group change observed |
| Van Blarigan et al., 2020 [28] | 50 | √ | √ | Compared to the control arm, the intervention arm had a significant improvement in whole grain consumption at 12 weeks (between-group difference: 0.9 servings/d, 95% CI: 0.1–1.6) | Not reported | ||
| Ferrante et al., 2018 [39] a | 35 | √ | √ | √ | No between-group difference observed | No within-group change observed | |
| Valle et al., 2017 [43] a | 35 | √ | √ | √ | No differences between groups over time in changes in dietary intake |
No within-group difference over time in dietary intake in any study group | |
| Gnagnarella et al., 2016 [45] | 125 | √ | No between-group difference observed | Nutritional questionnaire score improved in both groups | |||
| Quality of life (QoL) | |||||||
| Chow et al., 2020 [24] | 41 | √ | √ | √ | √ | No between-group difference in QoL over time observed | Compared to the baseline, significant improvements in physical (mean change: 2.7, 95% CI: 0.7–4.6) and mental health (mean change: 4.2, 95% CI: 1.5–6.9) were observed in the intervention group at 16 weeks |
| Rastogi et al., 2020 [26] b | 50 dyads | √ | √ | √ | Relative to the control group, the intervention group was associated with a moderate-to-large improvement in physical (effect size: 0.4, 95% CI 0.0–0.8) and mental health (effect size: 0.6, 95% CI 0.2–1.0) at 12 weeks | Compared to the baseline, significant improvements in aggregate physical health scores (mean change: 4.3, 95% CI: 0.2–8.4), mental health (mean change: 4.0, 95% CI: 1.5–6.5), role limitation due to emotional problems (mean change: 3.7, 95% CI: 0.1–7.2), and vitality (mean change: 6.1, 95% CI: 3.3–8.9) | |
| Mohamad et al., 2019 [31] | 62 | √ | √ | √ | Significant difference in overall QoL score changes between the intervention and control groups observed at 12 weeks (between-group difference: 12.3, 95% CI 4.9–19.7, p < 0.01) | Compared to the baseline, a significant improvement in functioning subscales was observed in the intervention group (mean change: 4.0, 95% CI 0.4–7.5, p = 0.03) while a significant decrease in the overall QoL score (mean change: −5.1, 95% CI −10.1 to −0.1) was observed in the mini-intervention (control) group at 12 weeks | |
| Mayer et al., 2017 [42] | 284 | √ | √ | √ | No between-group difference in QoL over time was observed | Not reported | |
| Golsteijn et al., 2018 [41] | 478 | √ | √ | Compared to the control group, a significant decrease in fatigue (between-group difference: −3.7, 95% CI: −6.8 to −0.5, p = 0.02) and improvement in physical functioning (between-group difference: 2.3, 95% CI: 0.5–4.1, p = 0.01) were observed in the intervention group |
Not reported | ||
| Kenfield et al., 2019[35] | 76 | √ | √ | √ | No difference in change in QoL measures between intervention and control groups | Not reported | |
| Ferrante et al., 2018 [39] | 35 | √ | √ | √ | No between-group difference in physical activity observed | Significant improvement in QoL observed in the intervention group (mean change: −9.4, 95% CI: −10.4 to −7.6, p = 0.03) | |
| Dong et al., 2019 [33] | 60 | √ | √ | Differences in change from the baseline favoring the intervention group in terms of vitality (p < 0.01), mental health (p < 0.01), and reported health transition (p < 0.01) when comparing the two groups at 12 weeks | Within-group change in role—physical (mean change: 25.0, p < 0.01), vitality (mean change: 5.2, p = 0.01), and mental health (mean change: 3.5, p = 0.01)—of SF-36 observed in intervention group from baseline to 12 weeks | ||
| Gnagnarella et al., 2016 [45] | 125 | √ | Difference in role functioning score change observed (p = 0.02) | Increased overall QoL scores observed in both groups | |||
| McNeil et al., 2019 [36] | 45 | √ | √ | No difference in self-reported QoL noted across time or between groups in this study | Not reported | ||
| Nguyen et al., 2020 [25] | Greater reductions in actigraphy-based awake time (min) after sleep onset (mean difference: −5.7, 95% CI: −11.7 to −0.2) and number of awakenings (mean difference: −2.0, 95% CI: −3.6–0.4) in the intervention arm compared to the waitlist arm at 12 weeks | In the intervention group, significant improvements in waking (min) after sleep onset (mean change: 2.1, SD: 3.4, p < 0.01), number of awakenings (mean change: −1.0, SD: 1.2, p = 0.06), and total PSQI score (mean change: −0.8, SD: 0.4, p = 0.03) were observed at 12 weeks and sleep efficiency (mean change: 2.1, SD: 3.4, p < 0.01) at 24 weeks |
|||||
Abbreviations: 95% CI, confidence interval; MVPA, moderate-to-vigorous physical activity; IQR, interquartile range; PSQI, Pittsburgh Sleep Quality Index; QoL, quality of life; SD, standard deviation. a These studies reported results for both physical activity and diet, separately. b [26,27] described the same study.