Efficacy of Telehealth-Based Coaching to Improve Physical Activity and Overall Experience for Cancer Survivors: Secondary, Mixed Methods Analysis of a Randomized Controlled Trial

Background Cancer survivors face significant challenges in maintaining adequate physical activity levels, which are essential for overall health and quality of life. Telehealth-based interventions offer promising opportunities to provide accessible support and promote healthier lifestyles throughout the cancer survivorship continuum. HealthScore is a telehealth coaching program designed to optimize the health of cancer survivors. Objective This study assessed the effectiveness of HealthScore in improving physical activity metrics among cancer survivors compared to controls. We also evaluated participants’ qualitative experiences with the program to understand its impact on motivation, accountability, and overall health-related quality of life. Methods We performed a secondary analysis of a randomized controlled study of cancer survivors who participated in a comprehensive health coaching intervention called HealthScore. Participants in control and intervention groups received a Fitbit activity tracker that collected heart rate, step counts, active minutes, and calories burned. These metrics were analyzed using statistical methods to compare overall averages and temporal trends between intervention and control groups. Eleven exit interviews were conducted with intervention arm participants to ascertain their experiences with HealthScore. Inductive thematic analysis was performed to identify emerging themes. Data were collected between May 2020 and March 2022. Results Of the 32 participants enrolled, 20 (62%) were in the intervention group. Compared to the control group, intervention participants had significantly higher average daily steps (mean 3660, SD 3344; 95% CI 3557-3764 vs mean 3408, SD 3288; 95% CI 3299-3518; P=.001) and more moving average daily steps (mean 4813, SD 1723; 95% CI 4680-4946 vs mean 4581, SD 1224; 95% CI 4494-4669; P=.003). Moving average daily step counts in the intervention arm showed an increasing trend, which was significantly higher than that of the control group (regression slope=5.89 vs 2.80; P<.001). Compared to the control group, the intervention participants had significantly higher average daily walking distance (mean 2.6, SD 2.5; 95% CI 2.5-2.7 vs mean 2.4, SD 2.3; 95% CI 2.3-2.5; P<.001) and more moving average daily walking distance (mean 3.5, SD 1.3; 95% CI 3.4-3.6 vs mean 3.2, SD 0.8; 95% CI 3.1-3.3; P<.001). Moving average daily walking distances among intervention participants increased, which was also significantly higher than that of the control group (regression slope=0.0046 vs 0.0017; P<.001). Participants in the intervention group reported a growing sense of accountability and motivation. One barrier was completing weekly monitoring of patient-reported outcome surveys, which focused on symptoms and physical function and did not always align with participants’ goals. Conclusions The HealthScore telehealth coaching program improved physical activity levels among cancer survivors and enhanced motivation and accountability. These findings support the integration of telehealth-based health coaching into posttreatment care, promoting healthier lifestyles and improved quality of life for cancer survivors. Trial Registration ClinicalTrials.gov NCT04923997; https://clinicaltrials.gov/study/NCT04923997