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Long-Term Engagement With a Physical Activity App Among Gynecologic Cancer Survivors in the LETSGO Trial: 12-Month
Sindre Herskedal Fosstveit1,2, Ingvild Vistad3,4, Mette Skorstad3,5
1Department of Sport Science and Physical Education, Faculty of Health and Sport Sciences, University of Agder, Universitetsveien 25, Kristiansand, 4630, Norway, 47 94822211.
Background:
Physical activity (PA) alleviates many treatment-related side effects in gynecologic cancer survivors, yet long-term PA levels remain low. Mobile health interventions can support self-management and increase PA levels; however, evidence from real-world, year-long engagement with smartphone apps in this population is still limited.
Objective:
The aim of this study is to describe 12-month user engagement with the PA component of a smartphone app implemented within a partially nurse-led routine follow-up in a real-world cohort of gynecologic cancer survivors.
Methods:
This descriptive study analyzed server-generated log data from the intervention arm of the prospective, multicenter, quasi-experimental LETSGO (Lifestyle and Empowerment Techniques in Survivorship of Gynecologic Oncology) trial (NCT04122235). Between December 2019 and July 2022, 378 cancer survivors (ovarian, endometrial, cervical, vulvar, or vaginal cancer) from 5 Norwegian hospitals were enrolled in the intervention arm and were offered the app plus a Garmin Vivofit 4 activity tracker alongside standard consultations. Primary outcomes for this study were (1) weekly PA registrations (objective step counts from the activity tracker and self-reported PAs) and (2) temporal patterns of step logging during each cancer survivor's first 52 weeks postenrollment. Secondary analyses compared baseline characteristics of app users (≥2 wk of PA logging) and nonusers.
Results:
Of 378 eligible participants (mean age 63, SD 13 y; BMI 28.5, SD 6.4 kg/m²), 272 (72%) logged at least 2 weeks of PA, and 225 (60%) synchronized objective step data. Mean daily steps were 5657 (SD 2799; median 5533, IQR 3499-7498). Step tracking dominated app use (mean 21, SD 16 logged wk), followed by self-reported walking (mean 23, SD 19 wk) and resistance training (mean 15, SD 16 wk). Weekly step-logger counts fell around study weeks 16, 32, and 44, but rebounded by 30 to 50 participants within 3 weeks, indicating episodic rather than permanent disengagement. App users were younger (mean difference -6.7 y, 95% CI -9.6 to -3.9; P<.001), more often employed (χ²1=12.7; P<.001), and more likely to have higher education (χ²2=13.6; P<.001) than nonusers. Tumor type and treatment modality were not associated with engagement.
Conclusions:
In a routine-care setting, nearly three-quarters of gynecologic cancer survivors engaged repeatedly with an app-supported PA module over 12 months, although mean PA levels were modest and participation was more prevalent among younger, employed, and more highly educated participants. Engagement followed an ebb-and-flow pattern, suggesting that built-in re-engagement prompts and equity-focused onboarding are needed to sustain and broaden participation. These findings support the feasibility of blended mobile health follow-up while highlighting the importance of adaptive strategies to promote long-term PA adherence and bridge the digital divide among cancer survivors.
