A Brief SMART Exercise Instant Messaging Support Intervention - a Pilot Study

Study Overview
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Brief Summary
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Lung cancer is one of the most common cancer diseases, globally and locally. Several health benefits of increased physical activity (PA) have been reported for people with cancer. PA plays a critical role across the cancer trajectory, from prevention through to post-diagnosis and has been proposed as an alternative for improving physical and psychosocial health outcomes, reducing cancer recurrence, and cancer-specific and all-cause mortality. Although there are a variety of exercise intervention programs for cancer patients, those programs were quite intensive, requiring individuals to commit extra time and effort. Feeling of overwhelmed appointments, lack of time, other barriers, including high cost and limited access to facilities are the most frequently reported barriers that prevent people from starting and maintaining exercise. Hence, the investigators propose to use a brief messaging lifestyle modification intervention program to incorporating simple and easy-to-do patient-centred home-based lifestyle-integrated exercise into daily activities of patients with lung cancer. The aims are to explore the feasibility of using instant messaging to enhance physical activity and improve their fatigue, emotion and quality of life, and obtain feedback from patients for intervention and study design improvement.

Detailed Description
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Lung cancer is one of the most common cancer, globally and locally. Patients with lung cancer are in a uniquely challenging situation in their disease, comorbidities, and treatment that may lead to worsened symptoms and many negative health consequences, including fatigue, irritability, and impaired daytime functioning. Physical activity (PA) is defined as 'any bodily movement produced by skeletal muscle that results in energy expenditure'. Several health benefits of increased PA have been reported for people with cancer. PA plays a critical role across the cancer trajectory, from prevention through to postdiagnosis and has been proposed as an alternative for improving physical and psychosocial health outcomes, reducing cancer recurrence, and cancer-specific and all-cause mortality. Although there are a variety of exercise intervention programs for cancer patients, those programs were quite intensive, requiring individuals to commit extra time and effort. Most clinicians underutilise exercise therapy, regardless of its low-cost way to improve symptoms and potential health outcomes. Feeling of overwhelmed appointments, lack of time, other barriers, including high cost and limited access to facilities are the most frequently reported barriers that prevent people from starting and maintaining exercise. Low motivation, fear to exercise, lack of knowledge about benefits are the most common barriers of engaging in physical activity for cancer patients. Hence, the current proposal is to use a brief messaging lifestyle modification intervention program to incorporating simple and easy-to-do patient-centred home-based lifestyle-integrated exercise (light to moderate physical activity) into daily activities of patients with lung cancer. The aims are to explore the feasibility of using instant messaging to enhance physical activity and improve their fatigue, emotion and quality of life, and obtain feedback from patients for intervention and study design improvement.

Official Title
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A Brief SMART Exercise With Chat-based Instant Messaging Personalised Support Intervention

Conditions
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Cancer, Lung

Intervention / Treatment
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* Behavioral: Brief messaging and personalized support


Participation Criteria
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Eligibility Criteria
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Inclusion criteria Aged 18 years and above; Diagnosis of non-small cell lung cancer or small cell lung cancer Fatigue symptom score ≥4 out of 10 Self-reported engagement of <150 minutes of moderate-intensity PA each week Ambulatory and capable of all self-care activities Either undergoing or finished oncology therapy and/or support care Mentally, cognitively and physically fit to join the trial Able to speak and read Chinese; Willing to complete the patient-reported outcome questionnaire Completion of the Physical Activity Readiness Questionnaire Possession of a smartphone with instant messaging functions such as WhatsApp or WeChat. Exclusion criteria Those preparing for lung operation Skeletal fragility Serious active infection Inability to walk Severe respiratory insufficiency Uncontrolled pain Diagnosed psychiatric illness such as major depressive disorder

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 100 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Intervention Model: Single Group Assignment
Interventional Model Description: The experimental group will receive a face-to-face group session and a package of information on lifestyle-integrated exercise and physical activity.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Lifestyle-integrated exercise and care support<br>The experimental group will receive a face-to-face group session and a package of instant messages related to lifestyle-integrated exercise and cancer-related information with personalized support. | Behavioral: Brief messaging and personalized support<br>* Patients will receive (i) a face-to-face group session and a package of instant messages related to lifestyle-integrated exercise (including breathing, balance, aerobic, strength, stretching exercises), cancer-related care information and support.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in fatigue level at 6 week | measured by Functional Assessment of Cancer Therapy - Fatigue subscale, the higher scores, the more fatigue. | Baseline and 6 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Anxiety and depressive symptoms at 6 weeks | measured by Hospital Anxiety and Depression Scale, Each item is answered on a 4-point scale (0-3). The scores for the seven questions on depression are added together to obtain a score ranged from 0 to 21. The higher score the more depressed. The scores for the seven questions on anxiety are added together to obtain a score ranged from 0 to 21. The higher score the more anxiety and depression symptoms. | Baseline and 6 weeks | 
| Change in sleep quality at 6 weeks | measured by the Pittsburgh sleep quality index . The higher the score, the worse the quality. | Baseline and 6 weeks | 
| Change in Health-related quality of life at 6 weeks | measured by the European Organization for Research and Treatment of Cancer and Lung Module. The higher scores the worse the quality. | Baseline and 6 weeks | 
| Change in Subjective Happiness at 6 weeks | measured by Subjective Happiness Scale. The higher scores the more happy. | Baseline and 6 weeks | 
| Change in Pain at 6 weeks | measured by a question with a scale from 0 to 10; a score of 0 indicates no pain at all, a score of 10 indicates severe pain. The higher score, the more pain. | Baseline and 6 weeks | 
| Change in dyspnea at 6 weeks | measured by a question with a scale from 0 to 10; a score of 0 indicates no dyspnea at all, a score of 10 indicates severe dyspnea. The higher score, the more dyspnea. | Baseline and 6 weeks | 
| Change in activity level at 6 weeks | measured by pedometer | Baseline and 6 weeks | 
| Change in hand grip strength at 6 weeks | measured by a dynamometer | Baseline and 6 weeks | 
| Change in balance at 6 weeks | measured by single leg stand test | Baseline and 6 weeks | 
| Change in flexibility at 6 weeks | measured by chair sit and reach test | Baseline and 6 weeks | 
| Change in sleep quality with objective measurement at 6 weeks | measured by activity monitor on duration of sleep and awake intervals | Baseline and 6 weeks | 
| Change in physical activity level with objective measurement at 6 weeks | measured by accelerometer on the daily walking steps | Baseline and 6 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Lifestyle modification, physical activity, e-messages