Authors:
Ya-Ting GAO RN, MN 1,2 ; Yan LOU PhD, Associate Professor 1 ; Ying LIN RN, MN 1 ; Shuai-Ni LI RN, MN 1,3 ; Mei-Rong HONG RN, BN 1 ; Yu-Lu XU RN, BN 1 ; Wei YU RN, BN 1
1.  School of Nursing, Department of Medicine, Hangzhou Normal University
2.  Sir Run Run Shaw Hospital (SRRSH), School of Medicine, Zhejiang University
3.  The Children's Hospital, School of Medicine, Zhejiang University


Cancer-related fatigue is a long-lasting and distressing symptom for CRC patients, and it would exhibit a detrimental effect on their quality of life. Physical activity could relieve fatigue, and aerobic exercise combined with resistance training can maximize the fatigue-relieving effect. Nevertheless, it has been challenging in promoting combined aerobic exercise and resistance training among CRC patients, especially training for improving lower limb flexibility, muscular strength, and endurance.1 Novel strategies are needed to enable these individuals to monitor their physical activity levels, encouraging them to set goals to achieve adequate physical activity levels for themselves. Mobile-health was suggested to be a desirable platform to administer physical activity program for this purpose.2

We conducted a study that aimed to design and implement a combined aerobic exercise and resistance training program for CRC patients with fatigue via a mobile-health platform. Overall, our twelve-week exercise program involved a combination of aerobic exercise and resistance training, and it was supplemented with flexibility exercises. Progressive increase in the frequency, intensity, duration and volume of the exercise have been introduced as the participants progressed through the program. The core elements of personalized intervention included an individualized goal setting, autonomous habit training, staged professional guidance and targeted interactive encouragement. The feasibility and applicability of the mobile-health-based personalized exercise management program for CRC patients with fatigue were also evaluated.

This study was conducted using a multi-step approach.

Step 1:  Development of the exercise movement library
Four exercise guidance movement libraries were established . Specific movements included: (i) the dynamic stretching movement library; (ii) the aerobic exercise movement library; (iii) the resistance training movement library (iv) the static stretching movement library. The combination of these movements forms three progressive aerobic exercise and resistance training sets.

Step 2:  Digitization of intervention program
We used multi-media technology including audio, video, and motion graphics to present the program and make it adaptable to the mobile-health platform.

Step 3: Evaluation of intervention program
Face-to-face or virtual expert consultation method were used to evaluate the feasibility and applicability of the program. Seven experts with a professional background of human kinesiology or nursing care for CRC patients validated the applicability of the exercise management program, and the suitability of movement library for CRC patients. These experts provided feedback and comments on the ways to improve the program.

Step 4: Design of the mobile-health platform
WeChat Mini Program was selected as the mobile-health platform for the presentation of the exercise management program. An iterative interactive process was used. The research team and the software designers held six rounds of face-to-face interviews, and online communications were also established with them, where the technical aspects of presenting the program via the mobile-health platform were discussed and sorted.  

Step 5: Preliminary test
Twenty CRC inpatients and their families were invited using a purposive sampling method to evaluate the WeChat Mini Program. Face-to-face semi-structured interviews were used to collect the qualitative data on the patients’ experience and feedback in using the WeChat Mini program. The thematic analysis method was used to extract themes from the data.

Overall, the development and implementation of the personalized exercise management program for colorectal cancer patients with fatigue appeared to be feasible. CRC patients and their families who participated in this program perceived that the WeChat Mini Program, “Huì Dòng” (Smart Exercise), was easy to use. Program content was suitable and beneficial for them to do exercises, and almost all of participants expressed willingness to continue using it, although two were concerned about the low potential of long-term adherence to the program. The WeChat Mini Program could be improved from the perspective of optimized format design, such as the use of light color background in the video, the incorporation of oral interpretation into the motion graph, and enhancement of cognition education on exercise. Further cohort studies should be conducted to evaluate its effect on the level of physical activity, the relief on CRF, self-efficacy in exercise and quality of life.



Figure: The Resistance Training Program-Beginning Level.

References

1. Nakagawa H, Sasai H, Tanaka K. Physical Fitness Levels among Colon Cancer Survivors with a Stoma: A Preliminary Study. Medicina (Kaunas). 2020 Nov 10;56(11):601. doi: 10.3390/medicina56110601.

2. Cheong IY, An SY, Cha WC, et al. Efficacy of Mobile Health Care Application and Wearable Device in Improvement of Physical Performance in Colorectal Cancer Patients Undergoing Chemotherapy. Clin Colorectal Cancer. Jun 2018;17(2):e353-e362.