Jason R. Bentley

Background: We recently completed the efficacy testing of an instructor-led yoga program for patients with thoracic cancer undergoing radiotherapy and their family caregivers. Translating an instructor-led intervention to a mobile app–based delivery model may facilitate the implementation of this yoga program in routine oncological clinical care. Objective: The current study seeks to develop a prototype of the app-based yoga program using a user-centric approach. Methods: Ten patients with a primary diagnosis of lung or esophageal cancer and their family caregivers (N=20) participated in structured interviews. Half of the sample had previously participated in the instructor-led yoga program, whereas half of the sample did not. Participants provided feedback on various mock-ups, wireframes, and yoga videos to guide the development of the app’s content, features, and workflow. Results: All patients (60% male; 70% non–Hispanic White; age: mean 62 years; 90% stage III) and their caregivers (90% female; 50% non–Hispanic White; age: mean 52 years) indicated that developing an app-based program is important and useful. Of the 20 participants, 95% mentioned that having an initial orientation with a yoga interventionist is important, and 90% stated that at least 1 check-in should be available (65% desired weekly check-ins). Participants provided feedback on characteristics of the instructor and instruction preferences. Other desired features included scheduling sessions on a calendar (95%), monitoring progress (95%), receiving practice reminders (90%), providing education on yoga as symptom management (90%), and providing daily inspiration (85%). All participants indicated the importance of including practices of various lengths. Conclusions: Both patients and caregivers deemed an app-based yoga program useful. Regardless of their level of yoga experience, almost all participants desired at least some contact with a live yoga instructor, although the desired frequency varied. These data have informed the development of a prototype that we are currently field-testing to ensure feasibility and acceptability.

PURPOSE: Patients with advanced thoracic cancers undergoing standard radiotherapy (RT) have a high risk of experiencing performance declines and poor quality of life (QOL). Exercise programs may improve objective and subjective performance; yet, adherence remains poor. Including family caregivers as active intervention, participants may improve adherence and thus efficacy. Thus, this clinical trial seeks to examine the efficacy of a patient-caregiver dyadic yoga intervention relative to a dose-matched education/support (ES) intervention. MATERIALS AND METHODS: Patients with lung or esophageal cancer undergoing at least 5 weeks of RT and their family caregivers were randomly assigned to either a 15-session yoga or ES comparison intervention. Patients and caregivers were assessed at baseline (T1), the last day of RT (T2) and 1 (T3), 2 (T4), and 3 (T5) months later. Patients completed the 6-minute walk test (6MWT; primary outcome) and both patients and caregivers completed a validated QOL measure (secondary outcomes). RESULTS: A total of 222 participants were randomly assigned. For the 6MWT, patients in the yoga group performed significantly better than those in the ES group across T2-T5 (least squared means [LSMs] in meters: yoga = 469 v ES = 441, P = .03). Patients in the yoga group also reported improved physical (LSMs: yoga = 44.7 v ES = 41.6, P = .03) but not mental QOL scores across T2-T5 compared with those in the ES group. As exploratory outcomes, patients in the yoga group also reported improved sleep ( P = .01) and coping efficacy ( P = .02). CONCLUSION: Yoga significantly improves functional capacity and subjective physical QOL in patients undergoing thoracic RT. Involving a family caregiver may improve intervention adherence.

BACKGROUND We recently completed the efficacy testing of an instructor-led yoga program for patients with thoracic cancer undergoing radiotherapy and their family caregivers. Translating an instructor-led intervention to a mobile app–based delivery model may facilitate the implementation of this yoga program in routine oncological clinical care. OBJECTIVE The current study seeks to develop a prototype of the app-based yoga program using a user-centric approach. METHODS Ten patients with a primary diagnosis of lung or esophageal cancer and their family caregivers (N=20) participated in structured interviews. Half of the sample had previously participated in the instructor-led yoga program, whereas half of the sample did not. Participants provided feedback on various mock-ups, wireframes, and yoga videos to guide the development of the app’s content, features, and workflow. RESULTS All patients (60% male; 70% non–Hispanic White; age: mean 62 years; 90% stage III) and their caregivers (90% female; 50% non–Hispanic White; age: mean 52 years) indicated that developing an app-based program is important and useful. Of the 20 participants, 95% mentioned that having an initial orientation with a yoga interventionist is important, and 90% stated that at least 1 check-in should be available (65% desired weekly check-ins). Participants provided feedback on characteristics of the instructor and instruction preferences. Other desired features included scheduling sessions on a calendar (95%), monitoring progress (95%), receiving practice reminders (90%), providing education on yoga as symptom management (90%), and providing daily inspiration (85%). All participants indicated the importance of including practices of various lengths. CONCLUSIONS Both patients and caregivers deemed an app-based yoga program useful. Regardless of their level of yoga experience, almost all participants desired at least some contact with a live yoga instructor, although the desired frequency varied. These data have informed the development of a prototype that we are currently field-testing to ensure feasibility and acceptability. CLINICALTRIAL

Background: Breast cancer survivors have a unique risk for negative health outcomes. Engaging in routine physical activity (PA) can reduce these risks. However, PA levels are low among this population. Narrative visualization (NV) is a technique that uses drawings, photographs, and text to contextualize data, which may increase integrated regulation, or motivation related to personal values and identity. A PA intervention targeting breast cancer survivors using an NV strategy may improve PA behavior. The purpose of this study was to determine whether scrapbooking activities could successfully be used as an NV strategy for older (55+) breast cancer survivors. Methods: Breast cancer survivors were given workbooks, wearable electronic activity monitors, instant cameras, and art supplies including a variety of stickers (e.g., emojis, affirmations). Participants were instructed to use these materials for 7 days. The workbook pages prompted participants to re-draw their daily activity graphs from the wearable’s mobile app, then annotate them with text, photographs, stickers, etc. to reflect what the data meant to them. Hybrid thematic analysis was used to analyze the photographs, drawings, and written content to identify emergent themes. Content analysis was also used to investigate use of stickers and photographs. Results: Of the 20 consented women (mean age 67 ± 5 years, 45% non-Hispanic white), 3 participants were lost to follow-up or unable to complete the procedures. The NV procedures were successfully utilized by the remaining 17 participants, who collectively used 945 stickers over 7 days, most of which were emojis. Emojis were both positively and negatively valanced. Participants took a mean of 9 photos over 7 days and completed workbook questions regarding current PA and PA goals. Themes within the photos included family, specific locations, everyday objects, religion, and friends. Themes within the written portions of the workbook included family, chores and obligations, health, personal reflection, hobbies, and shopping. Conclusions: The materials provided allowed breast cancer survivors to successfully use NV techniques to reflect on their PA data and behavior. These techniques show promise for promoting integrated regulation in activity monitoring interventions. Trial registration: This study was funded by the National Cancer Institute (R21CA218543) beginning July 1, 2018.

Background: Older adult women are at risk for negative health outcomes that engaging in sustained physical activity can help prevent. However, promoting long-term maintenance of physical activity in this population has proven to be a challenge. Increasing autonomous motivations (ie, intrinsic, integrated, and identified regulations) for physical activity may facilitate enduring behavior change. Digitally delivered games for health that take a celebratory technology approach, that is, using technology to create new ways to experience valued behaviors and express valued beliefs, may be a useful way to target autonomous motivations for physical activity. Formative research with the target population is needed to design compelling intervention content. Objective: The objective of this study is to investigate older adult women’s reactions to and thoughts about a photography-based, social media walking game targeting autonomous motivations for physical activity. Methods: During an individual semistructured interview, a moderator solicited feedback from 20 older adult women (age range 65-74 years) as part of formative research to develop a social media game featuring weekly walking challenges. The challenges were designed to target autonomous motivations for physical activity. Interviews were audio-recorded and transcribed verbatim. Two reviewers conducted thematic content analysis on interview transcripts. Results: We identified 3 overarching themes in qualitative data analysis. These reflected the playful experiences, value, and acceptability associated with the intervention challenges. Generally, participants understood what the challenges were asking them to do, proffered appropriate example responses, and indicated that the challenges would be enjoyable. Participants reported that the intervention content afforded many and varied playful experiences (eg, competition, discovery, exploration, expression, fellowship, humor, nurture, sensation). Further, participants indicated that the intervention increased their motivation for physical activity, occasioned meaningful shifts in perspective, increased their knowledge of various topics of interest, provided an opportunity to create valued connection with others, and provided health-related benefits. Participants suggested the intervention emphasize local history, nature, and cultural events. Conclusions: The photography-based, social media walking game with relatively simple game mechanics was well received and judged to be apt to bring about a wide variety of emotive experiences. A clear, geographically specific identity emerged as a key driver of interest for intervention content. Taking a celebratory technology approach holds promise for targeting autonomous motivations for physical activity in older adult women.

BACKGROUND Older adult women are at risk for negative health outcomes that engaging in sustained physical activity can help prevent. However, promoting long-term maintenance of physical activity in this population has proven to be a challenge. Increasing autonomous motivations (ie, intrinsic, integrated, and identified regulations) for physical activity may facilitate enduring behavior change. Digitally delivered games for health that take a celebratory technology approach, that is, using technology to create new ways to experience valued behaviors and express valued beliefs, may be a useful way to target autonomous motivations for physical activity. Formative research with the target population is needed to design compelling intervention content. OBJECTIVE The objective of this study is to investigate older adult women’s reactions to and thoughts about a photography-based, social media walking game targeting autonomous motivations for physical activity. METHODS During an individual semistructured interview, a moderator solicited feedback from 20 older adult women (age range 65-74 years) as part of formative research to develop a social media game featuring weekly walking challenges. The challenges were designed to target autonomous motivations for physical activity. Interviews were audio-recorded and transcribed verbatim. Two reviewers conducted thematic content analysis on interview transcripts. RESULTS We identified 3 overarching themes in qualitative data analysis. These reflected the playful experiences, value, and acceptability associated with the intervention challenges. Generally, participants understood what the challenges were asking them to do, proffered appropriate example responses, and indicated that the challenges would be enjoyable. Participants reported that the intervention content afforded many and varied playful experiences (eg, competition, discovery, exploration, expression, fellowship, humor, nurture, sensation). Further, participants indicated that the intervention increased their motivation for physical activity, occasioned meaningful shifts in perspective, increased their knowledge of various topics of interest, provided an opportunity to create valued connection with others, and provided health-related benefits. Participants suggested the intervention emphasize local history, nature, and cultural events. CONCLUSIONS The photography-based, social media walking game with relatively simple game mechanics was well received and judged to be apt to bring about a wide variety of emotive experiences. A clear, geographically specific identity emerged as a key driver of interest for intervention content. Taking a celebratory technology approach holds promise for targeting autonomous motivations for physical activity in older adult women.

Purpose: Physical activity (PA) levels are low among breast cancer survivors. Narrative visualization (NV) is a technique that uses drawings, photographs, and text to contextualize data, which may increase integrated regulation, or motivation for PA by relating it to personal values and identity. The purpose of this study was to determine the acceptability of a NV intervention for older breast cancer survivors.Methods: Participants completed an NV workbook for 7 days using the provided instant camera, art supplies including a variety of stickers, and a wearable electronic activity monitor. The workbook pages prompted participants to re-draw their daily activity graphs from the monitor’s mobile app, then annotate them with text, photographs, stickers, etc. to reflect what the data meant to them. Thematic analysis and content analysis were used to identify emergent themes. Results: Of the 20 consented women (mean age 67±5 years, 45% non-Hispanic White), 17 participants completed all study procedures. Participants showed high levels of engagement (e.g., mean of 9 photos taken; mean of 56 stickers used over 7 days; all workbook questions completed) supporting intervention acceptability. Themes within the photos included family, specific locations, everyday objects, religion, and friends. Themes within the written portions of the workbook included family, chores and obligations, health, personal reflection, hobbies, and shopping. Weight loss was not a major theme. Conclusions: Breast cancer survivors successfully used NV techniques to reflect on their PA data and behavior. These techniques show promise for promoting integrated regulation in activity monitoring interventions.Trial Registration: NCT03612596