Lee, M.K., Yun, Y.H., Park, H.A., Lee, E.S., Jung, K.H., & Noh, D. (2014). A web-based self-management exercise and diet intervention for breast cancer survivors: Pilot randomized controlled trial. International Journal of Nursing Studies, 51, 1557–1567. 

To investigate whether a web-based self-management exercise and diet intervention (WBSEDI) is feasible and effective in patients with breast cancer to promote exercise and diet

Control versus 12-week WBSEDI. WBSEDIs were encouraged to be completed at least twice weekly. Education content included enhancing exercise and diet behavior in survivors; the importance of weight management; barriers to sustaining exercise and diet; planning exercise and diet; outcomes of regular exercise and diet; and exercise and diet recommendations for cancer survivors. Content was divided into modules based on patients' stage of change. The type and duration of exercise was decided by the patient. Diets were based on daily calorie requirements and food-group unit recommendations. Automatic feedback was provided in the module. The control group received a 50-page booklet of module information without transtheoretical model use.

• N = 57  
• MEAN AGE: 43.2 years (control group), 41.5 years (experimental group)
• FEMALES: 100%
• KEY DISEASE CHARACTERISTICS: Mean time since treatment = 156.6 days (control), 161.6 days (experimental). 43/59 patients had breast-conserving therapy, 49/59 patients received chemotherapy, and 52/59 patients received radiotherapy. All participants completed primary therapy within last 12 months before study enrollment.
• OTHER KEY SAMPLE CHARACTERISTICS: Percent completing college or beyond: Control 69%, experimental 76.7%

• SITE: Multi-site    
• SETTING TYPE: Home    
• LOCATION: South Korea

• PHASE OF CARE: Late effects and survivorship

Pilot randomized controlled trial

• Primary outcomes: Exercise and fruit and vegetable intake, dietary quality using diary and recall.  
• Secondary outcomes: Health-related quality of life (HRQOL) using the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ–C30) 
• Anxiety and depression using the Hospital Anxiety and Depression Scale (HADS) 
• Fatigue using the Brief Fatigue Inventory (BFI) 
• Stage of change using open-ended questions 
• Perceived self-efficacy using Likert scale

89% of the experimental group consistently participated in the intervention. There was a significant increase in the intervention group for moderate-intensity exercise of 150 minutes per week (p < .0001) and five servings fruits and vegetables per day (p = .001). Secondary outcomes were significant improvements in the intervention group at 12 weeks for physical functioning (p = .023), fatigue (p = .032), and appetite loss (p = .034). The stage of change for exercise and fruit and vegetable consumption was significantly higher (p < .0001 and p = .029).

The intervention arm had a low attrition rate with a high percentage of participation. Secondary outcomes such as fatigue were associated with improved primary outcomes, suggesting increased exercise and improved diet can have an effect on quality of life and function for breast cancer survivors. Patient stage of change can affect participation in interventions. The cost and implementation of web-based intervention was not discussed, which may limit some institutions in using it.

• Small sample (< 100)
• Risk of bias (no blinding)
• Intervention expensive, impractical, or training needs
• Other limitations/explanation: Large number of identified patients excluded from study (113/172)

Web-based interventions may be effective for patients seeking lifestyle interventions that include ongoing support and feedback.