In my last blog post I’ve briefly explained the research topics related to my PhD project and how I aim to design of a physical activity app for breast cancer survivors, while also exploring personalization/tailoring theory to increase user engagement. In this blog post I will provide a brief review of physical activity apps, found in published literature that were specifically designed for this population.
I’ve extracted papers from 3 online databases (PubMed, ACM and SCOPUS) on the 24th of January 2019 and, after analyzing the search results, I’ve identified 4 apps that provided coaching on physical activity and were designed for post-treatment breast cancer survivors. Here I present a summary of these systems features:
Not much detail were provided on the system design, but here are some of the features that seem to be included:
Paired with a pedometer (InBodyBand);
Exercise training prescribed by clinicians;
A plan subdivided into aerobic and resistance exercises;
Personalization of plan based on physical level at baseline, the patient’s overall condition and the patient’s performance;
The goal in minutes/week of aerobic exercise can be adjusted to the user, and the difficulty of the resistance training can be increased by using elastic Thera-bands;
Video clips showing the resistance exercises;
Manual input by the user of the number of sets carried out in a session;
Display of activity achievement rates on a weekly basis.
You can find some screenshots of the app in Fig. 1.
A study where 88 breast cancer patients used this app for 12 weeks showed positive results on exercise achievements and overall satisfaction of use.
Fig.1 Screenshots of SmartAfterCancer application.
MHA was designed to target patients with prostate and breast cancers, having 2 different versions of the same system, with content and exercises specific to each cancer type. The app includes components regarding weight control, activity, mood and sleep; exercises for after surgery; and supportive information.
The features from the physical activity component are (Fig. 2):
Activity tracking module based on GPS, that provides place and activity information through time;
Monitors the steps, distance, duration and calories spent
Historical records of activity;
Includes a map to provide spatiotemporal visualization of the user’s locations and routes;
Records and displays information on sitting behaviour;
The breast cancer version provides tailored exercises for recovery after surgery (see Fig. 3).
The app was tested with 197 breast and prostate cancer patients but only regarding technical matters and to improve functionalities.
Fig.2 Screenshots of activity suite of MHA app for prostate cancer (similar in the breast cancer version) and screenshots of exercises specific to breast cancer survivors after surgery.
Bounce features include:
A physical activity intervention with three exercise categories (see Fig. 3 - image 1): aerobics, flexibility, and strength;
A FAQ tab and cautionary warnings (see Fig. 3 - image 2)
Rich data visualizations on activity progress (number of steps and exercise duration) and weekly performance (see Fig. 3 - image 3);
Gamification techniques, such as badges and trophies;
Pop-up notifications to remind and encourage users to perform a physical activity;
Congratulatory notifications on achievements;
Option to connect to similar users and remotely follow the same plan and share their experiences and tips for exercising;
A virtual exercise trainer that provides: (1) a written description and (2) a visual step-by-step demonstration (see Fig. 3 - image 5);
Provides incremental levels and progress indicators (see Fig. 3 - image 6).
In a preliminary system evaluation, participants found the application engaging and useful, and continued to use it briefly after the evaluation ended.
(The features of FAQ tabs and cautionary warnings, and social interaction, are yet to be implemented).
Fig.3 Screenshots showing the Bounce app features.
Among other app modules that aim to control diet, the exercise plan module of PhytoCloud includes:
Activity recommendations organized in light, moderate and vigorous intensities;
An exercise plan that can be selected or created by the user;
A diary, where users can check progress and edit or delete activity entries;
Goals and exercise plan adapted based on the user profile information;
Option to look for other similar members, to share exercise plans and to comment or rate the plans from others.
No user testing was performed with PhytoCloud app at this stage.
Main considerations:
It is clear that research on mobile physical activity apps for breast cancer survivors is still in its infancy – with only 4 apps found in this literature search;
There seems to be a concern by the researchers to consider the users’ insights in the design process;
The papers highlighted the importance of including a highly tailored experience to these individuals, adapted to the users’ needs and goals – this can improve engagement with the app and increase adherence to physical activity.
Only 1 of the apps was designed based on behaviour change theories and empirical evidence, which is a requirement for these type of technologies;
There is a lack of focus in creating well-designed and motivating experiences;
There is a lack of proper evaluation of these systems and the effects of specific features.
You can find further information on these systems by accessing the following references:
[Lee, H., Uhm, K.E., Cheong, I.Y. et al. J Med Syst (2018) 42: 254. https://doi.org/10.1007/s10916-018-1096-1]
[Zhang Xu, Deng Zhikun, Parvinzamir Farzad and Dong Feng (2018) MyHealthAvatar lifestyle management support for cancer patients ecancer 12 849]
[G. Marcu et al. 2018. Bounce: Designing a Physical Activity Intervention for Breast Cancer Survivors. In Proceedings of the 12th EAI International Conference on Pervasive Computing Technologies for Healthcare (PervasiveHealth '18). ACM, New York, NY, USA, 25-34.]
[Meghan M. Plank and Nishtha H. Dalal. 2016. Bounce: A Mobile Behavioral Intervention Technology for Breast Cancer Survivors. In Proceedings of the 2016 CHI Conference Extended Abstracts on Human Factors in Computing Systems (CHI EA '16). ACM, New York, NY, USA, 98-103.]
[PhytoCloud: A Gamified Mobile Web Application to Modulate Diet and Physical Activity of Women with Breast Cancer," 2017 IEEE 30th International Symposium on Computer-Based Medical Systems (CBMS), Thessaloniki, Greece, 2017, pp. 684-689.]
More details about my project will come in the next blog posts, so stay tuned ;).