Galiano-Castillo, N., Cantarero-Villanueva, I., Fernandez-Lao, C., Ariza-Garcia, A., Diaz-Rodriguez, L., Del-Moral-Avila, R., & Arroyo-Morales, M. (2016). Telehealth system: A randomized controlled trial evaluating the impact of an internet-based exercise intervention on quality of life, pain, muscle strength, and fatigue in breast cancer survivors. Cancer. Advance online publication.

To evaluate the effectiveness of a the telehealth-delivered exercise intervention on symptoms among breast cancer survivors

Patients were randomized to the telehealth intervention or usual care. After baseline assessment, those in the study group received instructions on how to access the private area of the system. The intervention consisted of three sessions per week of exercise following recommendations of the American College of Sports Medicine for cancer survivors. Each session was delivered online. The system allowed participants to send messages and set up video conferencing, participants to write questions or comments, and research staff to comment and monitor performance remotely. Participants received phone calls from research staff if needed. The intervention lasted eight weeks. Usual care patients received basic written recommendations for exercise. After six months, they were offered the opportunity to participate in the telehealth program. Assessments were done at baseline, at completion, and at six months.

• N = 72   
• MEAN AGE = 48.3 years
• FEMALES: 100%
• CURRENT TREATMENT: Not applicable
• KEY DISEASE CHARACTERISTICS: All had breast cancer and previous surgery. Most also had previous radiotherapy and chemotherapy.
• OTHER KEY SAMPLE CHARACTERISTICS: Most had surgery within the last 12 months.

• SITE: Single site   
• SETTING TYPE: Home    
• LOCATION: Spain

• PHASE OF CARE: Late effects and survivorship

• Randomized, controlled trial

• EORTC Cancer Core Quality of Life (EORTC QLQ-C30) and EORTC Breast Cancer Quality of Life (QLQ-BR23)
• Brief Pain Inventory (BPI)
• Handgrip strength
• Isometric abdominal and back strength 
• Sit-to-stand test for lower body strength
• Piper Fatigue Scale (PFS)

After the intervention, the telehealth group reported lower pain severity (p = 0.001) and interference (p = 0.045). The telehealth group reported improved total fatigue perception compared to controls (p = 0.001). This improvement was maintained at the six month follow-up (ES d = –0.75, p = 0.002). Adherence rate for exercise sessions was 93.9%. Muscle strength and quality of life (QOL) were also improved in the telehealth group compared to controls. There were no technical issues or adverse effects of the intervention observed.

An online exercise and interaction approach was effective in reducing pain and fatigue and improving QOL and muscle strength. The program had good patient adherence.

• Small sample (< 100)
• Risk of bias (no blinding)
• Risk of bias (no appropriate attentional control condition)
• Intervention was expensive and impractical, or training needs existed.
• Baseline pain and type of pain are not reported.  
• Baseline fatigue was lower among the intervention group.
• Authors noted that a large number of staff were involved in the provision of this program, which may limit the ability to sustain this type of program.

The online delivery of an interactive exercise intervention was shown to be effective. An Internet-based intervention may be a useful alternative to traditional approaches to deliver such interventions, particularly in the setting of barriers such as distance and time. The comparative costs for staff time to deliver and maintain this type of intervention need to be evaluated.