Rianne Henrica Johanna Golsteijn

BACKGROUND Cancer incidence is steadily increasing worldwide. Reduced physical activity (PA), sleep disturbances, and high levels of psychological stress are prevalent within cancer patients. These impairments reduce quality of life and functional recovery and are linked to increased societal costs. Despite this, support to improve PA and sleep quality and reduce psychological stress remains insufficiently integrated into routine oncological care. Healthcare professionals face structural and organisational barriers to providing lifestyle guidance, while patients report unmet supportive care needs. eHealth interventions offer opportunities to deliver tailored lifestyle support. However, evidence on the efficacy, economic outcomes, and implementation of eHealth interventions embedded within routine oncological care remains limited. OBJECTIVE This study protocol describes the design of a randomised controlled trial that assesses the efficacy of CARE-FIT, a blended eHealth intervention integrated into routine oncological care, targeting PA, sleep quality, and psychological stress. The study consists of an efficacy evaluation, a process evaluation, and both trial- and model-based economic evaluations. METHODS A non-blinded, parallel-group, randomised controlled trial was conducted across hospitals, rehabilitation centres, and physiotherapy practices in the Netherlands. Healthcare organisations were stratified and randomised to either the CARE-FIT intervention plus usual care or usual care alone. Adult patients diagnosed with cancer from the time of diagnosis up to 1 year after completion of curative treatment were eligible. Participants receiving CARE-FIT were provided with theory-informed, tailored online advisory sessions and modules and an activity tracker throughout the 12-week intervention period. Healthcare professionals referred patients to the intervention during routine consultations. Outcomes were assessed at baseline, 12 weeks, and 24 weeks. For the efficacy evaluation, primary outcomes included objectively measured PA and self-reported PA, sleep quality, and psychological stress. Secondary outcomes included fatigue and health-related quality of life. Multilevel linear mixed-effects models were used in accordance with the intention-to-treat principle. For the process evaluation, intervention use, appreciation, and implementation experiences among patients and healthcare professionals were assessed. The economic evaluation comprised cost-effectiveness and cost-utility analyses conducted from a societal perspective using both trial-based and model-based approaches, alongside a budget impact analysis. RESULTS Participants were recruited from September 2025 to April 2026 through 41 participating healthcare organisations, including 15 hospital departments, 4 rehabilitation centres, and 22 physiotherapy practices. The study aimed to include 356 participants, with 178 participants in each condition. CONCLUSIONS The described trial will provide comprehensive evidence regarding the clinical efficacy, economic outcomes, and implementation of a blended eHealth lifestyle intervention embedded in routine oncological care. By integrating these components within a multicentre design, the study will provide insights into the feasibility and sustainable implementation of lifestyle support for individuals living with and beyond cancer. CLINICALTRIAL ISRCTN Registry ISRCTN61846887; https://www.isrctn.com/ISRCTN61846887

Vocational education and training (VET) educates students for a broad range of occupations, which may be associated with differences in habitual physical activity behavior (PAB). Research suggests that physical activity (PA) is positively and sedentary behavior (SB) is negatively associated with cognitive performance. Therefore, we aimed to compare habitual PAB in VET students from different educational tracks and investigate its association with cognitive performance in a cross-sectional study. Students wore an ActivPAL accelerometer continuously for seven days to measure PAB. Cognitive performance was assessed with objective tests for inhibition, shifting, and updating. Hairdresser and Sports students sat significantly less than Administrative and Nursing students. Hairdresser students stood significantly more than other tracks. Admin students stood significantly less than Sports/Nursing students. Sports students moved significantly more than Hairdresser and Nursing students. Time in bed was significantly lowest in Nursing students. No significant associations between any PAB and cognitive performance were found. In general, Admin students showed the unhealthiest habitual PAB. Higher PA or lower SB neither improve nor decrease cognitive performance. Thus, future health interventions focusing on exchanging SB for PA at schools can facilitate a healthier lifestyle of VET students, especially in Admin students, without interfering with cognitive performance.

While it has been shown that interrupting a person’s sedentary behaviour has the potential to improve cognitive, physical and mental health, a large part of time that students spend in school is sedentary. As research has shown that approximately 80% of vocational education and training (VET) students have an unhealthy sedentary lifestyle, implementing “sit-to-stand” (StS) desks could interrupt sedentary behaviour and promote healthier behaviour. Therefore, the acceptability and feasibility of using such desks in the VET setting should be investigated. Using semi-structured focus group interviews analysed via deductive content analysis, the opinions of 33 students for the following topics were assessed: (1) usage of the standing option of the desks (2) reasons for standing in class (3) experienced effect of standing behind the desk, and (4) fostering future StS desks usage. Although VET students are aware of the potential benefits of using StS desks, they need to be actively stimulated and motivated by teachers to use them. In addition, time is needed to get into the habit of standing. Thus, for successful implementation of StS desks in the VET setting, all stakeholders (i.e., students, teachers, schoolboards) should be actively involved in stimulating the healthy behaviour of VET students.

Physical activity (PA) is beneficial in improving negative physical and psychological effects of cancer and cancer treatment, but adherence to PA guidelines is low. Computer-tailored PA interventions can reach large populations with little resources. They match with patients’ preference for home-based, unsupervised PA programs and are thus promising for the growing population of cancer survivors. The current study assessed the efficacy of a computer-tailored PA intervention in (four subgroups of) prostate and colorectal cancer survivors. Prostate and colorectal cancer patients and survivors were randomized to the OncoActive intervention group (N = 249), or a usual-care waiting-list control group (N = 229). OncoActive participants received a pedometer and computer-tailored PA advice, both Web-based via an interactive website and with printed materials. Minutes moderate-to-vigorous PA (MVPA) and days ≥30 min PA were assessed with an accelerometer (ActiGraph) at baseline and 6 months. Further, questionnaires were used to assess self-reported PA, fatigue, distress, and quality of life at baseline, 3 and 6 months. Differences between both groups were assessed using linear regression analyses (complete cases and intention-to-treat). In addition, efficacy in relation to age, gender, education, type of cancer, and time since treatment was examined. Three months after baseline OncoActive participants significantly increased their self-reported PA (PA days: d = 0.46; MVPA: d = 0.23). Physical functioning (d = 0.23) and fatigue (d = − 0.21) also improved significantly after three months. Six months after baseline, self-reported PA (PA days: d = 0.51; MVPA: d = 0.37) and ActiGraph MVPA (d = 0.27) increased significantly, and ActiGraph days (d = 0.16) increased borderline significantly (p = .05; d = 0.16). Furthermore, OncoActive participants reported significantly improvements in physical functioning (d = 0.14), fatigue (d = − 0.23) and depression (d = − 0.32). Similar results were found for intention-to-treat analyses. Higher increases in PA were found for colorectal cancer participants at 3 months, and for medium and highly educated participants’ PA at 6 months. Health outcomes at 6 months were more prominent in colorectal cancer participants and in women. The OncoActive intervention was effective at increasing PA in prostate and colorectal cancer patients and survivors. Health-related effects were especially apparent in colorectal cancer participants. The intervention provides opportunities to accelerate cancer recovery. Long-term follow-up should examine further sustainability of these effects. The study was registered in the Dutch Trial Register ( NTR4296 ) on October 17 2018.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet

Cancer and cancer treatment coincide with substantial negative physical, psychological and psychosocial problems. Physical activity (PA) can positively affect the negative effects of cancer and cancer treatment and thereby increase quality of life in CPS. Nevertheless, only a minority of CPS meet PA guidelines. We developed the OncoActive (OncoActief in Dutch) intervention: a computer-tailored PA program to stimulate PA in prostate and colorectal CPS, because to our knowledge there are only a few PA interventions for these specific cancer types in the Netherlands The OncoActive intervention was developed through systematic adaptation of a proven effective, evidence-based, computer-tailored PA intervention for adults over fifty, called Active Plus. The Intervention Mapping (IM) protocol was used to guide the systematic adaptation. A literature study and interviews with prostate and colorectal CPS and health care professionals revealed that both general and cancer-specific PA determinants are important and should be addressed. Change objectives, theoretical methods and applications and the actual program content were adapted to address the specific needs, beliefs and cancer-related issues of prostate and colorectal CPS. Intervention participants received tailored PA advice three times, on internet and with printed materials, and a pedometer to set goals to improve PA. Pre- and pilot tests showed that the intervention was highly appreciated (target group) and regarded safe and feasible (healthcare professionals). The effectiveness of the intervention is being evaluated in a randomized controlled trial (RCT) (n = 428), consisting of an intervention group and a usual care waiting-list control group, with follow-up measurements at three, six and twelve months. Participants are recruited from seventeen hospitals and with posters, flyers and calls in several media. Using the Intervention Mapping protocol resulted in a systematically adapted, theory and evidence-based intervention providing tailored PA advice to prostate and colorectal CPS. If the intervention turns out to be effective in increasing PA, as evaluated in a RCT, possibilities for nationwide implementation and extension to other cancer types will be explored. The study is registered in the Dutch Trial Register (NTR4296) on November 23rd 2013 and can be accessed at http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4296 .

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Physical activity (PA) is beneficial in improving negative physical and psychological effects of cancer. The rapidly increasing number of cancer survivors, resulting from aging and improved cancer care, emphasizes the importance to develop and provide low cost, easy accessible PA programs. Such programs could be provided through the Internet, but that could result in the exclusion of cancer survivors not familiar with the Internet. Therefore, we developed a computer-tailored PA intervention for prostate and colorectal cancer survivors in which both Web-based and print materials are provided, and participants can choose their own preferred delivery mode. Objective: The aim of this study was to assess participants’ characteristics related to delivery mode and use of intervention materials. Methods: We studied characteristics of participants using Web-based and printed intervention materials in a randomized controlled trial (RCT). Prostate and colorectal cancer survivors recruited from hospitals were randomized to OncoActive (computer-tailored PA intervention) or a usual-care control group. OncoActive participants received both Web-based and printed materials. Participants were classified into initial print- or Web-based participants based on their preferred mode of completion of the first questionnaire, which was needed for the computer-tailored PA advice. Intervention material use during the remainder of the intervention was compared for initial print- or Web-based participants. Additionally, participants were classified into those using only print materials and those using Web-based materials. Differences in participant characteristics and intervention material use were studied through analysis of variance (ANOVAs), chi-square tests, and logistic regressions. Results: The majority of the participants in the intervention group were classified as initial Web-based participants (170/249, 68.3%), and 84.9% (191/249) used Web-based intervention materials. Dropout was low (15/249, 6.0%) and differed between initial Web-based (4/170, 2.4%) and print-based (11/79, 14%) participants. Participants were less likely to start Web-based with higher age (odds ratio [OR]=0.93), longer time since last treatment (OR=0.87), and higher fatigue (OR=0.96), and more likely with higher education (OR=4.08) and having completed treatments (OR=5.58). Those who were older (OR=0.93) and post treatment for a longer time (OR=0.86) were less likely to use Web-based intervention materials. Initial print-based participants predominantly used print-based materials, whereas initial Web-based participants used both print- and Web-based materials. Conclusions: To our knowledge, this is one of the first studies that assessed participant characteristics related to delivery mode in an intervention in which participants had a free choice of delivery modes. Use of print-based materials among the initial Web-based participants was substantial, indicating the importance of print-based materials. According to our findings, it may be important to offer Web- and print-based materials alongside each other. Providing Web-based materials only may exclude older, less educated, more fatigued, or currently treated participants; these groups are especially more vulnerable and could benefit most from PA interventions.

Physical inactivity is a significant predictor of several chronic diseases, becoming more prevalent as people age. Since the aging population increases demands on healthcare budgets, effectively stimulating physical activity (PA) against acceptable costs is of major relevance. This study provides insight into long-term health outcomes and cost-effectiveness of a tailored PA intervention among adults aged over fifty. Intervention participants (N = 1729) received tailored advice three times within four months, targeting the psychosocial determinants of PA. The intervention was delivered in different conditions (i.e. print-delivered versus Web-based, and with or without additional information on local PA opportunities). In a clustered RCT, the effects of the different intervention conditions were compared to each other and to a control group. Effects on weekly Metabolic Equivalents (MET)-hours of PA obtained one year after the intervention started were extrapolated to long-term outcomes (5-year, 10-year and lifetime horizons) in terms of health effects and quality-adjusted life years (QALYs) and its effect on healthcare costs, using a computer simulation model. Combining the model outcomes with intervention cost estimates, this study provides insight into the long-term cost-effectiveness of the intervention. Incremental cost-effectiveness ratios (ICERs) were calculated. For all extrapolated time horizons, the printed and the Web-based intervention resulted in decreased incidence numbers for diabetes, colon cancer, breast cancer, acute myocardial infarctions, and stroke and increased QALYs as a result of increased PA. Considering a societal Willingness-to-Pay of €20,000/QALY, on a lifetime horizon the printed (ICER = €7,500/QALY) as well as the Web-based interventions (ICER = €10,100/QALY) were cost-effective. On a 5-year time horizon, the Web-based intervention was preferred over the printed intervention. On a 10-year and lifetime horizon, the printed intervention was the preferred intervention condition, since the monetary savings of the Web-based intervention did no longer outweigh its lower effects. Adding environmental information resulted in a lower cost-effectiveness. A tailored PA intervention in a printed delivery mode, without environmental information, has the most potential for being cost-effective in adults aged over 50. The current study was registered at the Dutch Trial Register ( NTR2297 ; April 26th 2010).