The objective of the study is to determine the efficacy of a 12-week mobile chat-based exercise counselling intervention (ChatEx) for increasing exercise behaviour (operationalized as self-reported aerobic MVPA) at 3-month (primary analysis, post-intervention) and 6-month (3-month post-intervention) among older cancer survivors. This will be a randomized controlled, assessor-blind trial conforming to the CONSORT guidelines. A total of 196 cancer survivors aged over 60 who have completed curative treatment and screened as having an ECOG performance status of 0 or 1 will be recruited and randomized into intervention and control groups. It is expected that upon intervention completion, the intervention group will exhibit increased and sustained exercise behaviors compared to the control group. Study instruments will be Physical Activity Scale for the Elderly, 6-minute walk test, grip strength, Edmonton Frail Scale, European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire, M-PAC constructs, and a background questionnaire. The intervention comprises of 12 weeks of messages aimed at promoting physical activity structured with the multi-process action control framework complemented with two face-to-face exercise instructional sessions at week 1 and week 6. The control group participants will receive a one-page written information sheet on the recommended exercise guidelines and exercise safety precautions in cancer survivors. Also, they will receive 3-4 messages via IM monthly on non-exercise-related self-management tips of cancer survivorship. They can receive the ChatEx intervention upon completion of the study. Intention-to-treat analysis will be performed.
Older adults account for more than half of cancer diagnoses. With advances in detection and treatment, older adults constitute the fastest-growing segment in the cancer population. A history of cancer has been found to increase the odds of and accelerate functional decline, suggesting that cancer and/or its treatment alters aging trajectories. Therapeutic interventions are therefore needed to mitigate the consequences of cancer and aging. Robust evidence indicates that exercise attenuates the major hallmarks of aging. Meanwhile, exercise is recommended by multiple best practice guidelines to alleviate the adverse sequelae of cancer. Well-documented benefits include improvements in physical functioning and quality of life (QoL), reduction of cancer-related symptoms (e.g., fatigue, insomnia, depression), and decreasing risk of recurrence, secondary cancers, and mortality. Exercise counseling, which involves advice and discussions to promote exercise, is a less intensive and more scalable approach than supervised exercise sessions. Instant messaging (IM) offers a promising platform for delivering exercise counseling due to its accessibility, customizability, and widespread use. This study utilizes the Multi-Process Action Control (M-PAC) framework, which emphasizes reflective, regulatory, and reflexive processes to overcome barriers to exercise adherence. The study hypothesizes that ChatEx, an IM-based exercise counseling intervention grounded in the M-PAC framework, will be effective in increasing and maintaining exercise behavior among older cancer survivors. This study aims to evaluate the efficacy of a 12-week mobile chat-based exercise counseling intervention (ChatEx) for increasing exercise behavior in older cancer survivors. The primary objective is to determine if ChatEx can increase exercise behavior at both 3-month (post-intervention) and 6-month (3-month post-intervention) time points. Secondary aims include examining the intervention's impact on other exercise parameters, exercise capacity, grip strength, frailty, and quality of life, as well as exploring the mediating roles of Multi-Process Action Control (M-PAC) constructs and participant engagement in changing exercise behavior.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
SINGLE
Enrollment
196
The 12 weeks of messages will be sent by a trained counsellor. At baseline, participants will select their desired IM application (WhatsApp/WeChat), timing of messages (morning/noon/afternoon), message format (audio/text), and language style (spoken/written). The message library, established in the HMRF-funded study, consists of messages in text and pre-recorded voice message formats, images, videos, and stickers. Each week starts with messages on factual information and ends with a question to initiate conversations to clear any queries; counsellor will provide real-time replies. The 12-week messages are structured based on the M-PAC framework.
Exercise behaviour
Exercise behaviour (primary outcome) is operationalized as the self-reported time spent in aerobic MVPA per week. It will be assessed using the Physical Activity Scale for the Elderly (PASE) \[35\], a 12-item scale on three components of physical activity of older adults, including leisure-time activity (light/moderate/vigorous aerobic exercise and resistance exercise), household activity, and work-related activity. The number of hours spent on each activity/day over a 7-day period is recorded. Frequency is multiplied by duration to obtain the total time spent in aerobic MVPA. The total time spent in resistance exercise will be extracted in the same manner. An overall PASE score will be calculated to estimate total exercise time (all types of activities) by summing all components according to the item weights specified. Besides, objectively-measured time spent in MVPA will be measured by instructing participants to wear an activity sensor for 2 consecutive days at each time point.
Time frame: (a) pre-intervention at study entry (T0, baseline); (b) 3-month (T1; post-intervention); (c) 6-month (T2; 3 months post-intervention)
Exercise capacity
Exercise capacity will be measured by the 6-minute walk test, which is well-correlated with peak VO2 and highly reproducible. Participants will be instructed to walk at their fastest pace and cover the longest possible distance in 6 minutes.
Time frame: (a) pre-intervention at study entry (T0, baseline); (b) 3-month (T1; post-intervention); (c) 6-month (T2; 3 months post-intervention)
Grip strength
Grip strength will be assessed using a dynamometer for six attempts in an alternating bilateral sequence (three with each arm, with a rest period of 30s between each trial). An average of the attempts will be recorded.
Time frame: (a) pre-intervention at study entry (T0, baseline); (b) 3-month (T1; post-intervention); (c) 6-month (T2; 3 months post-intervention)
Health-related quality of life
Health-related quality of life will be measured using the 30-item European Organization for research and Treatment of Cancer Core Quality of Life Questionnaire, which has been validated in Chinese cancer patients with satisfactory reliability
Time frame: (a) pre-intervention at study entry (T0, baseline); (b) 3-month (T1; post-intervention); (c) 6-month (T2; 3 months post-intervention)
Frailty
Frailty will be measured using the 11-item Edmonton Frail Scale. This covers nine domains of frailty (e.g., cognition, mood, functional performance). Higher total scores represent more severe frailty states.
Time frame: (a) pre-intervention at study entry (T0, baseline); (b) 3-month (T1; post-intervention); (c) 6-month (T2; 3 months post-intervention)
M-PAC constructs
M-PAC constructs (e.g., affective attitude, instrumental attitude, perceived capability, perceived opportunity, habit, identity) will be measured using 21 items designed by our co-A (Rhodes, M-PAC founder).
Time frame: (a) pre-intervention at study entry (T0, baseline); (b) 3-month (T1; post-intervention); (c) 6-month (T2; 3 months post-intervention)
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.