Effectiveness of Combined Smartwatch and Social Media Intervention on Breast Cancer Survivor Health Outcomes: A 10-Week Pilot Randomized Trial

Physical activity (PA) among breast cancer survivors (BCS) can improve this population’s health and quality of life (QoL). This study evaluated the effectiveness of a combined smartwatch- and social media-based health education intervention on BCS’s health outcomes. Thirty BCS (X¯age = 52.6 ± 9.3 years; X¯Wt = 80.2 ± 19.6 kg) participated in this 10-week, 2-arm randomized trial, with BCS randomized into: (1) experimental group (n = 16): received Polar M400 smartwatches for daily PA tracking and joined a Facebook group wherein Social Cognitive Theory-related PA tips were provided twice weekly; and (2) comparison group (n = 14): only joined separate, but content-identical Facebook group. Outcomes included PA, physiological, psychosocial, and QoL variables. Specifically, PA and energy expenditure (EE) was assessed by ActiGraph GT3X+ accelerometers while physiological, psychosocial, and QoL were examined via validated instruments at baseline and post-intervention. No baseline group differences were observed for any variable. Ten BCS dropped out of the study (experimental: 4; comparison: 6). Compared to completers, dropouts differed significantly on several outcomes. Thus, a per-protocol analysis was performed, revealing significant group differences for changes in social support (t = −2.1, p = 0.05) and barriers (t = −2.2, p = 0.04). Interestingly, the comparison group demonstrated improvements for both variables while the intervention group demonstrated slightly decreased social support and no change in barriers. Notably, both groups demonstrated similarly increased daily light PA, moderate-to-vigorous PA, EE, and steps of 7.7 min, 5.1 min, 25.1 kcals, and 339 steps, respectively, over time. Despite extensive user training, several experimental BCS found the Polar M400 use difficult—possibly decreasing intervention adherence. Future interventions should utilize simpler smartwatches to promote PA among middle-aged clinical/non-clinical populations.

morning. In this manner, you will have to move the clothes prior to opening the door, acting as a reminder to be a little more physically active during the day or to not skip the gym in the evening.

Socialcognitive belief(s) targeted: Promoting Self-Efficacy, Decreasing Barriers
Week 5 Monday: Setting realistic, yet challenging goals can be a great way to sustain motivation to remain physically active. For example, set the goal of increasing the distance you walk by one-quarter mile each week until you reach three miles. At three miles, consider a walk-run pattern wherein you walk for one minute and then jog for one minute. You can repeat this pattern for a designated amount of time (e.g., 30 minutes) or for a certain distance (e.g., 3 miles). As it gets easier, gradually introduce more jogging and less walking. Social-cognitive belief(s) targeted: Promoting Self-Efficacy Thursday: Blisters and chaffing caused by the wrong workout clothes/shoes can be a serious threat to continued participation in physical activity. Thus, consider an investment in proper (and good-looking) athletic clothes and shoes. Doing so may just help increase your motivation to be physically active while also decreasing the likelihood of experiencing painful skin irritation! Social-cognitive belief(s) targeted: Decreasing Barriers, Improving Outcome Expectancy Week 6 Monday: Again, social support is important to physical activity participation. If you are engaging in a new physical activity program, perhaps tell your family and close friends about your new program. Stating your plans out loud not only increases the likelihood that you will continue this physical activity program, but your family and friends will surely ask about it at some point in the future meaning you may be held accountable for sticking to this program! Social-cognitive belief(s) targeted: Enhancing Social Support Thursday: Water is vital. Although recommendations put forth my numerous health organizations such as the Centers for Disease Control and Prevention and the American College of Sports Medicine state 6-8 cups a day is needed, this does not always hold true for all individuals. Therefore, if you are not confident in your ability to drink enough water, buy a good water bottle that can be used at the gym and during the day and drink each time you feel thirsty. Further, drinking consistently throughout the day can help decrease your appetite and improve digestion, helping you lose weight. Social-cognitive belief(s) targeted: Promoting Self-Efficacy, Improving Outcome Expectancy Week 7 Monday: One of the best ways to ensure you continue to participate in a physical activity program is finding an activity you enjoy. If you are an individual who prefers to workout alone, perhaps swimming, running, or biking suits you the best. For individuals who prefer to workout with others, consider group exercise classes such as yoga or step aerobics such as Zumba or dancing. Additionally, do not be afraid to mix and match different types of exercise! If you are going to sweat you might as well be doing something that interests you! Social-cognitive belief(s) targeted: Increasing Enjoyment, Enhancing Social Support Thursday: Face it, you have put in the time in the gym and, perhaps, even lost a little weight in the process. Consider a monthly reward. This reward can be anything from the purchase of that one shirt that you have been dying to add to your wardrobe to a night out with your significant other. Yet, whatever the reward is, make sure that it does not derail your quest for better health and participation in physical activity.

Social-cognitive belief(s) targeted: Improving Outcome Expectancy
Week 8 Monday: Did you know that physical activity has been linked to greater feelings of well-being? Well, it has! Physical activity, even in bouts as short as ten minutes can increase "good" hormones within the body such as endorphins. Indeed, release of these hormones on a regular basis as a result of continued physical activity participation has been found to lower likelihood of diseases such as depression and increase self-esteem. Social-cognitive belief(s) targeted: Improving Outcome Expectancy Thursday: Sitting at a desk all day is not healthy. Consider setting your watch or phone to beep every thirty minutes during the day at which point you HAVE to get up and go for a five minute walk or engage in some light stretching. Not only will this give your body a much needed boost, it might also give your mind the break in concentration it needs and allow you to be more productive while doing homework or completing work for your job.

Social-cognitive belief(s) targeted: Improving Outcome Expectancy
Week 9 Monday: Ensure you do not pull a muscle during your workout. Start each exercise session with some light exercise such as jumping jacks, brisk walking, or light biking/weight lifting. This will allow you to heat your core temperature up to a point wherein physical activity engagement does not pose much risk to your body.

Social-cognitive belief(s) targeted: Decreasing Barriers
Thursday: Static stretching prior to exercise may actually decrease workout performance and, due to the fact the muscles are not warm, is not increasing flexibility. However, engaging in static stretching after engaging in physical activity is one of the best ways to increase flexibility and may even help with delayed-onset muscle soreness. Ensure your stretching routine is sufficient to stretch all major muscles of the upper and lower body. Further, only stretch to the point of slight discomfort, not pain, and hold the stretch for 20 seconds.

Social-cognitive belief(s) targeted: Promoting Self-Efficacy, Improving Outcome Expectancy
Week 10 Monday: Sleep may not seem important to physical activity, but it is. Not getting enough sleep is a surefire way to experience decreases in motivation for engaging in physical activity. Therefore, aim for 6 to 8 hours of sleep each night. Moreover, try to cut out all screen time in the 10 to 15 minutes prior to going to sleep as watching TV or using your computer/smartphone to cruise social media or read the news decreases the body's ability to produce melatonin, a key sleep hormone. Finally, consider removing any TV from the bedroom and/or not playing music while you sleep as this background noise can actually decrease sleep quality. Making these small changes can go a long way in helping you feel more rested and ready to engage in physical activity (and life) the next day! Social-cognitive belief(s) targeted: Promoting Self-Efficacy, Decreasing Barriers Thursday: Crank those tunes! If music is something you know will get you motivated to engage in your workout, consider investing in some athletic-oriented headphones that are sweat resistant and capable of staying in the ear during exercise. Keeping an up-to-date playlist of your favorite songs will allow you to have a better workout. This is especially true of exercisers preferring to exercise indoors. However, if exercising outdoors, consider leaving the headphones at home and enjoying the scenery as use of headphones while exercising outdoors can put you in danger.

Supplementary Materials 2. Exercise made easy: beginners programming.
Below is a 10-week outline (40 workouts) of exercise programming for individuals with little experience in the gym or those just coming back from a long time away from the gym. As such, this workout program is programmed for exercise 4 times a week for roughly an hour, with simple exercises placed within. Notably, under each of the main exercises for each day are suggested alternative exercises which may better appeal to breast cancer survivors recovering from treatment.
Finally, for each cardio workout listed below, you will use the Rating of Perceived Exertion (RPE) scale to gauge your intensity level. This scale is listed below, allowing for comprehension of the intensity level each cardio workout should be completed at.

Month 1: Endurance Phase
For each strength exercise, the endurance phase of this program will include higher numbers of repetitions (10-12 repetitions for each set) for each exercise with lower weight. You should rest for 60 seconds to 1.5 minutes between each strength exercise. A Diagrammatic explanation for each exercise is available starting on Page 20 of this workout program. For each cardio workout, feel free to select your favorite cardio exercise. Some cardio exercise options include, but are not limited to: walking, jogging, running, biking, swimming, stairclimbing, rowing, elliptical exercise, etc.
Week 1 Day 1: For each strength exercise, the strength phase of this program will include a moderate number of repetitions (7-9 repetitions for each set) for each exercise with moderate weight. You should rest for 1.5 to 2.5 minutes between each strength exercise. A Diagrammatic explanation for each exercise is available starting on Page 20 of this workout program. For each cardio workout, feel free to select your favorite cardio exercise. Some cardio exercise options include, but are not limited to: walking, jogging, running, biking, swimming, stairclimbing, rowing, elliptical exercise, etc.