Erin Spain, MS [00:00:10] This is Breakthroughs. A podcast from Northwestern University Feinberg School of Medicine. I'm Erin Spain, host of the show. There's strong evidence that physical activity can play an important role in the health and lifespan of cancer survivors. Yet, many cancer survivors are not very active. A team of scientists at Northwestern University Feinberg School of Medicine's Exercise and Health Lab are designing, testing, implementing and disseminating physical activity interventions with the goal of helping more cancer survivors start and stick to an effective exercise routine. Dr. Siobhan Phillips is the principal investigator of this lab, and she joins me with details of this work. She is an associate professor in the Division of Behavioral Medicine and the Department of Preventive Medicine at Feinberg. She's also the director of physical activity promotion at the Cancer Survivor Institute within the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. Welcome to the show.
Siobhan Phillips, PhD, MPH [00:01:15] Thank you for having me.
Erin Spain, MS [00:01:17] You are leading a lab that is really focused on physical activity interventions and cancer survivors. So tell me about the lab and some of the work that you're doing there.
Siobhan Phillips, PhD, MPH [00:01:28] We are really trying to figure out how to get people more active. We know 150 minutes per week of moderate and vigorous physical activity is what's needed. But so few people actually get that level of activity. And we can say it has all these benefits, but if we can't actually get people to do it, we won't see those benefits. And so we're really focused on trying to understand how to help people engage in more physical activity, trying to figure out essentially what the active intervention components are for individuals to become more active. So how to make our interventions more effective, efficient and scalable so that we can hopefully translate some of this work from exercise and cancer survivorship into practice.
Erin Spain, MS [00:02:07] Why is it difficult? I mean, it's difficult for anybody to get all those minutes, but specifically for folks who are cancer survivors, what are some of the reasons.
Siobhan Phillips, PhD, MPH [00:02:16] A lot of cancer survivors undergo treatments that are not necessarily specific to killing cancer cells. So, these treatments can also damage normal healthy cells, which puts them at a higher risk for side effects of treatment. And because of this, it can make it more challenging. So oftentimes, cancer survivors experience fatigue, anxiety, depression. They might have issues with functional limitations. And because of that, it can be even harder to exercise. And so trying to help them deal with the normal things that everybody experiences, like not enough time or the weather and adding on the treatment can make it even more difficult for them to be physically active.
Erin Spain, MS [00:03:01] But to be clear, it's very safe and effective for cancer survivors or people who are undergoing treatment to take on this type of moderate to vigorous physical activity. Isn't that right?
Siobhan Phillips, PhD, MPH [00:03:12] Yes. So there's a lot of data that suggests it's safe. And I think particularly in the post-treatment period. And I think there's been a lot of emerging data that has now also made people realize that it is safe and effective during treatment for cancer survivors. But honestly, even doing something, some activity, light activity, the data really support that that's better than nothing. So just keeping moving, even if you can't quite get to that moderate and vigorous, especially during treatment, is still beneficial as opposed to doing nothing. Where we used to tell people to rest and take it easy. And now we're learning that really if you can stay active during treatment, it's one of the best things that you can do.
Erin Spain, MS [00:03:48] How has wearable technology really revolutionized what you're able to do in the lab?
Siobhan Phillips, PhD, MPH [00:03:54] Fitbits have been essential to actually all of our interventions. They're great tools for people. They're very easy for our cancer survivors to use to set up, which makes them great for distributing to a lot of people. And kind of on our end, it's really useful because we can monitor what they're doing in real time. So we used to have to kind of capture that information from paper and pencil logs, which you can imagine people did not always adhere to doing and then they'd have to get them to us. And so this has made it so much easier because we can monitor in real time what they're doing. We can help tailor the interventions to what they're doing. If they're improving a lot, we can suggest they do more. If they're not doing as well adhering, we can suggest they do a little bit less know if we don't get any data from them we can also reach out to them to make sure that they're doing okay, that they don't need help with anything, that there's no issues. And so it's really revolutionized essentially how we are able to do these remotely-delivered interventions more effectively and efficiently.
Erin Spain, MS [00:04:52] You mentioned using Fitbits quite a bit in your studies. Why Fitbits?
Siobhan Phillips, PhD, MPH [00:04:56] So they've been very well validated. They've shown to be really accurate in terms of their measurements according to kind of our gold standards of measurement. That's one of the things. They're super easy for participants to to set up. Another thing is the price point. So I've been very resistant to going with more expensive monitors because I had really wanted our research to have a higher translation potential. And so we've used more of the lower end Fitbits even in our research. And that's been a conscious choice because we want to do something that is a price point people might be able to afford easier than some of these fancier monitors. We provide the wearables as part of our studies and we let them keep them. I think it would be great and maybe someday we'll get where, you know, insurance companies are doing rebates and things like that. And I think as we're able to understand the data better and the utility of it, we might get there because we use mostly just activity data. But there's the heart rate data, there's the sleep data, all of these data. I actually had a participant who reached out to us and said she was looking at our sleep data and it prompted her to reach out to her doctor and then to get evaluated for sleep apnea. And then it turns out she had sleep apnea. But I think that there are a lot of uses beyond just activity tracking and combining that with the activity tracking to understand the whole person.
Erin Spain, MS [00:06:23] Do they wear them 24/7? Is that what you encourage people to do?
Siobhan Phillips, PhD, MPH [00:06:27] We do encourage them to wear it 24/7. Most people do. At a minimum, we ask them to wear it during all waking hours because we've been primarily focused on activity and in our trials that are just getting started, we're actually also measuring sleep. So we will be asking them, you know, encouraging them to wear it primarily 24/7.
Erin Spain, MS [00:06:44] Let's talk about a study that you published last year in the journal Cancer. This was a randomized controlled trial with breast cancer survivors. And the study used one of your interventions called Fit to Thrive. So tell me about this study and the result.
Siobhan Phillips, PhD, MPH [00:06:59] We did Fit to Thrive because, again, you know, cancer survivors are known to be inactive, particularly breast cancer survivors. About 70% don't meet the recommendations for physical activity. And so we developed, we co-developed an app with breast cancer survivors. So we engaged them in the whole process of basically developing this app and also helping us decide what would be in the intervention, what they thought would be useful to other breast cancer survivors. And so again, we used an approach to try to determine which components would be most effective for promoting physical activity in this population. All breast cancer survivors in the intervention got what we called a core intervention, and this consisted of the Fitbit and a basic version of our Fit to Thrive app. And then we randomly assigned them to get between 0 to 5 other components, either got them or they didn't get them. And so these components were biweekly telephone support calls, a more deluxe version of the Fit to Thrive app. So it had more features, a Fitbit buddy, where they selected somebody from their personal life, an online gym, where we gave them a schedule and tools to do exercises at home and then also tailored app text messaging. And so we were really trying to get survivors to get to 150 minutes per week. We gradually gave them recommendations to do that. We found that overall participants increased their activity almost an hour per week from 98 minutes to 151 on average. So we got to that goal and that there was also a significant increase in the proportion of survivors who met the physical activity guidelines after participation in the intervention.
Erin Spain, MS [00:08:37] So this was a 12 week intervention and then a 12 week follow up. Now, do you know what happens after that? Are people able to stick with the program?
Siobhan Phillips, PhD, MPH [00:08:46] We found that our effects were maintained but attenuated at 24 week follow up. So at 12 weeks they had increased our activity by an hour to an average of 151 minutes. But then at follow up, they had slipped back a little bit and their average was 122 minutes. So they were still doing better than they did, were at baseline, but not as well as they had done at 12 weeks. Once we left them on their own, to own devices.
Erin Spain, MS [00:09:11] So that really does say something for that sort of human element. The folks running the study. Tell me about that and maybe how important it is to have other resources besides the piece of technology.
Siobhan Phillips, PhD, MPH [00:09:21] So I think technology is a very great tool. I think we're still trying to figure out how much of the human element is necessary. Right. And how much people actually need. And it probably differs based on individuals. And so in our intervention, we did have support calls that were biweekly that half the people got and half didn’t. And interestingly enough, we didn't find that those people actually increased their activity more with support calls on versus off, which we were surprised by. But I think some of the human element just has to do with knowing that we were tracking them. If they weren't wearing their Fitbits, we were reaching out to that and that element of things and sending them messages and sending them emails just knowing that we were out there, I do think actually was effective and I think we're still trying to determine how much human do we need? I think we probably still need some. But what the right amount is.
Erin Spain, MS [00:10:11] Something now that you're looking at is that maybe this one size fits all approach isn't right and that you can take more of a personalized medicine approach to your interventions. Tell me how you're doing that in this new study that's underway called My Activity.
Siobhan Phillips, PhD, MPH [00:10:29] So in My Activity, we adopted this idea that maybe everybody doesn't need everything. And rather than necessarily saying, okay, this component on versus off, why don't we start with something very basic and give it to everybody and see what happens? And so in that trial, we do we start off with the technology we give people the Fitbits and the Fitbits are actually connected to the electronic health record in that case. And then we basically give them goals and observe them. And if they are not meeting those goals, then we consider them as not responding to this kind of basic and tech-based intervention. And then they have the opportunity to get randomized to either coaching calls, and these occur by weekly or another tech-based component that's just more intensive. So again, it's an online gym. We give them this nice little tool kit with everything they need a schedule to do and really trying to understand who this minimal and tech-based intervention works for. And then if it doesn't, you know, should we be augmenting with a human element or is another text-based intervention equally as effective in helping people get back to meet their goals? They have the opportunity to get randomized every month for the first six months of the study, and then we have a six month follow up period where we basically are just monitoring them to see what happens. The tech-based intervention continues and they have access to the online gym if they were randomized there. But really trying to understand what happens and what people need to increase their activity.
Erin Spain, MS [00:12:08] How many people are you recruiting for this study?
Siobhan Phillips, PhD, MPH [00:12:10] So it's a study that's here and at the University of Wisconsin, Madison, and we just finished recruitment. Our target was 320 and we got 323 individuals into the study.
Erin Spain, MS [00:12:21] How do you see physical activity really transforming some of these subjects lives?
Siobhan Phillips, PhD, MPH [00:12:26] We've had a lot of participants that will reach out to us and say, This has been so helpful to me. I wasn't getting off the couch before I joined your intervention, and then I joined and I was able to gradually do it. And this is the first time in my life I've been regularly active or we've had people who were really active before their cancer diagnosis and just couldn't get back into it. And they've reached out and said, This has really helped me get back on track and back to where I was at. And, you know, I'm able to do things that I didn't think I would be able to do again. And I really appreciated the support from your team and from the intervention, and that's why I do this work. There's a lot of benefits of physical activity that are both physical and mental, and I think that it can really help a lot of people and just trying to make it manageable for them is really important because I think you know we all tend to adopt this all or nothing attitude and we've really tried to focus on get there, try a little bit, get off the couch, and then next week try five more minutes and really trying to help them just see that they can do it and really build their belief in themselves so that they can succeed.
Erin Spain, MS [00:13:37] Implementation Science has become a research pillar at Feinberg, and there's a new center, there's new faculty, there's more folks who are coming to really make sure that implementation science is taking place and that all these studies that are happening at Northwestern are making it into the clinic and into the real world. Tell me about that and how that might benefit the work that you're doing.
Siobhan Phillips, PhD, MPH [00:14:01] I am super excited that the critical mass is building in that area at Northwestern. All my studies have had this idea of dissemination implementation in mind from the start. So I think with these new resources and new investigators, we really have the opportunity to take some of the work that we've done and transform it and potentially get it into cancer care so we can reach more of the people who could benefit from our programs. And we actually did receive funding myself with Bonnie Spring, who's the contact PI, Brian Hitsman and Sofia Garcia to implement a lifestyle intervention to decrease smoking, improve obesity and improve physical activity in cancer survivors within the Northwestern Medicine system. And so we're really excited to take some of the work that we've been doing in physical activity, some of the work that Dr. Spring has been doing and obesity and the work that Dr. Hitsman has been doing with smoking and the work Sofia Garcia has been doing in cancer survivorship more broadly, and being able to potentially get those interventions to the people who need them at a larger scale.
Erin Spain, MS [00:15:08] Technology changes so fast. Wearables are changing so fast. Tell me about the future. What do you see that could be coming that you could be using in these studies to help you and to help the participants exercise more?
Siobhan Phillips, PhD, MPH [00:15:23] It is changing very rapidly. The amount of data that we are able to get from participants. We feel like there are so much we could use this data to understand so much more than we even have done yet. And so I think really partnering with engineers and data scientists to to first make sense of the data, but then also to think about how we could use it to create more personalized interventions. We recently completed a study in metastatic breast cancer patients, and we were using their Fitbit data plus symptom ratings to try to help tailor step goals, the walking goals for them for the next day and the amount of tailoring we could do could be so much more sophisticated from that. That's really the tip of the iceberg. And the integration with the health data is also a really key area that I think we're just starting to get into. So you could give people Fitbits at home and potentially predicting medical events before they happen so that you could intervene and improve the outcome. So, essentially you might be able to observe that somebody has a low step count and this at a specific threshold is more likely to result in the hospitalization. And you could set up alerts to essentially alert a clinician, hey, your patient's steps are in that critical window. You might want to reach out and then they might be able to reach out to the patient and intervene before they end up in the hospital. And I think there's a lot of opportunities. You know, there's a lot of data that we could integrate to make our interventions more effective and also more tailored to individuals to make them just more useful.
Erin Spain, MS [00:16:59] The research that you're doing is going to be needed more than ever because there are going to be more cancer survivors out there in the world. Tell me about that and some of the projections.
Siobhan Phillips, PhD, MPH [00:17:10] The cancer survivor population is large and growing. A lot of this has to do with advances in early detection and treatment. And so we're catching cancer earlier, which is great because then it increases the rates of survival. The other interesting fact is that this cancer is a disease of aging. So not only is the population growing, but the population of older cancer survivors is growing. And this kind of the normal trajectory of aging plus kind of adding in cancer to that causes potentially more issues for aging older adults who have had a history of cancer. And so I think that's a really big area that's up and coming and really trying to focus more on older cancer survivors and to help them become more active and continue to age more successfully.
Erin Spain, MS [00:18:06] Thank you so much for coming on the show and talking about your research today.
Siobhan Phillips, PhD, MPH [00:18:10] Thank you for having me. I really enjoyed it.
Erin Spain, MS [00:18:22] Thanks for listening and be sure to subscribe to this show on Apple Podcasts or wherever you listen to podcasts and rate and reviews. Also, for medical professionals, this episode of Breakthroughs is available for CME Credit. Go to our website Feinberg.Northwestern.edu and search CME.