Optimization of mHealth behavioral interventions for patients with chronic lymphocytic leukemia: the HEALTH4CLL study

Che Young Lee; Max J Gordon; Melissa M Markofski; Emily C LaVoy; Susan K Peterson; Liang Li; Sara Fares; Miranda Baum; Margaret Pace; Danielle Walsh; Alessandra Ferrajoli; Karen Basen-Engquist

doi:10.1007/s11764-024-01555-w

Optimization of mHealth behavioral interventions for patients with chronic lymphocytic leukemia: the HEALTH4CLL study

J Cancer Surviv. 2024 Mar 13. doi: 10.1007/s11764-024-01555-w. Online ahead of print.

Authors

Affiliations

¹ Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1440, Houston, TX, 77030, USA.
² Department of Leukemia, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 428, Houston, TX, 77030, USA.
³ Department of Health and Human Performance, University of Houston, 3875 Holman St., Rm 104 Garrison, Houston, TX, 77204, USA.
⁴ Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1330, Houston, TX, 77030, USA.
⁵ Department of Biostatistics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1411, Houston, TX, 77030, USA.
⁶ Department of Leukemia, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 428, Houston, TX, 77030, USA. kbasenen@mdanderson.org.
⁷ Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1440, Houston, TX, 77030, USA. aferrajo@mdanderson.org.

PMID: 38472612
DOI: 10.1007/s11764-024-01555-w

Abstract

Purpose: This pilot study of a diet and physical activity intervention (HEALTH4CLL) was conducted to reduce fatigue and improve physical function (PF) in patients with chronic lymphocytic leukemia (CLL).

Methods: The HEALTH4CLL study used a randomized factorial design based on the multiphase optimization strategy (MOST). Patients received diet, exercise, and body weight management instructional materials plus a Fitbit and were randomized to undergo one of 16 combinations of 4 evidence-based mHealth intervention strategies over 16 weeks. Patients' fatigue, PF, health-related quality of life, behavior changes, and program satisfaction and retention were assessed. Paired t-tests were used to examine changes in outcomes from baseline to follow-up among patients. Factorial analysis of variance examined effective intervention components and their combinations regarding improvement in fatigue and PF scores.

Results: Among 31 patients, we observed significant improvements in fatigue (+ 11.8; t = 4.08, p = 0.001) and PF (+ 2.6; t = 2.75, p = 0.01) scores. The combination of resistance and aerobic exercise with daily self-monitoring was associated with improved fatigue scores (β = 3.857, SE = 1.617, p = 0.027). Analysis of the individual components of the MOST design demonstrated greater improvement in the PF score with resistance plus aerobic exercise than with aerobic exercise alone (β = 2.257, SE = 1.071, p = 0.048).

Conclusions: Combined aerobic and resistance exercise and daily self-monitoring improved PF and reduced fatigue in patients with CLL.

Implications for cancer survivors: This pilot study supported the feasibility of a low-touch mHealth intervention for survivors of CLL and provided preliminary evidence that exercising, particularly resistance exercise, can improve their symptoms and quality of life.

Keywords: Cancer; Exercise; Non-Hodgkin lymphoma; Nutrition; Physical activity; Skeletal muscle function.