The benefits of physical activity during cancer care and rehabilitation are well established, however introducing and maintaining healthy behaviors in the long-term remains challenging. Technological advances in electrically assisted bicycles and on-board sensors led us to propose an original rehabilitation program combining smart electric bicycle outings with health education.
This was a pilot study with physical activity questionnaires and endurance tests to evaluate physical activity following a 6-week program comprising 2 bicycle outings per week in groups of 5 (supervised or not) with briefing and debriefing supplemented by health education sessions. Fourteen post-breast cancer patients participated (median age 52 [IQR 46–55]). A gain of at least 2 International Physical Activity Questionnaire points and over 600 MET.min/week was achieved by 9/10 (90%; 95%CI[55.5–99.7]) women.
The feasibility of the program was clearly demonstrated, with excellent patient adherence (11/12 planned 2 h outings per patient). The electric bicycle program strengthened the womens’ physiological capacities through personalized levels of electrical assistance made possible by the fine settings of the motorization. This enabled the whole group to achieve the outing objectives together despite very variable levels of deconditioning. The pleasure shared in the group activity and personal empowerment gained should promote long-term maintenance of physical activity.
Introduction
A recent large cohort study confirmed that any gain in physical activity (PA) increases longevity regardless of the initial level of activity, especially in middle aged adults and patients with cancer [1]. Moreover, the value of physical activity in preventing cancer is well known and documented, particularly for breast cancer. Indeed, a 2016 meta-analysis of 38 articles reporting on cohort follow-up showed that the most physically active women significantly decreased their risk of developing breast cancer [2]. Physical activity is also beneficial for patients undergoing treatment and convalescing from breast cancer treatment. In addition, PA seems interesting in tertiary prevention as demonstrated by meta-analysis carried out in 2019 which showed that those breast cancer survivors who were the most physically active had a significantly reduced risk of death [3]. Positive effects include muscle strengthening, better physical condition, less fatigue, better sleep, and improved quality of life [4], [5], [6], [7]. Reconditioning through supervised exercise has shown its short-term interest for improving all of these criteria. but the data in the literature do not confirm this interest in the long term. However, in daily practice we see that the continued pursuit of PA is difficult to maintain over time, which can partly explain inadequate results in the long term. [8, 9].
Encouraging a mindset that includes motivation and self-discipline to maintain healthy behaviors in general, or the adoption of habits and the creation of conditions that help patients to maintain physical activity are concepts that have been well described in the literature [10, 11]. Likewise, the value of health education in promoting lifestyle changes leading to healthier behavior is well documented [12, 13]. Health education is all the more effective if it integrates the different aspects of a healthy lifestyle (PA, good nutrition, self-confidence etc.).
In this context, it seems necessary to think about collaborative, integrated and contextualized PA with the possibility of post-rehabilitation support in order to increase the chances of maintaining healthy behaviors acquired during rehabilitation [14, 15]. One solution to this is to propose tools that allow group activity that is fun and easy to do in real life conditions. The electric bicycle has promise in meeting these objectives and has already demonstrated its acceptability in patients with chronic diseases [16]. However, its use to promote health requires good control of the level of activity to ensure patient safety. To achieve this, a prototype electrically assisted bicycle (EAB), was specifically developed and tested in a pilot study on healthy subjects, highlighting its accessibility, simplicity and safety of use [17]. The smart electric bicycle incorporates electronics allowing optimal cycling assistance that can be personalized at any time thanks to an original algorithm that is adjustable via a smartphone. In real time the app integrates, analyzes and transmits parameters from the bike (motor power, battery charge, etc.) and from the patient (muscle power, heart rate, pedaling rate) as well as data relating to the outing (altitude difference, route, distance etc.). We hypothesize that by allowing personalization of sessions carried out outdoors in groups, the use of this EAB will promote the maintenance of post-rehabilitation physical activity, and provide empowerment to patients by maintaining the benefits acquired during rehabilitation. The objective of this pilot study was therefore to test, using a before/after design, the effects of a multidisciplinary program on the amount of physical activity undertaken and the physical condition of patients following a course of treatment for breast cancer.
Study design
Single-center prospective, longitudinal non-randomized pilot study performed in collaboration between the Rocheplane medical center (Audavie foundation), Saint Martin d'Hères, Grenoble Alpes University Hospital and Grenoble Alpes University, France between October 2017 and October 2018.
Population
Adult post-breast cancer patients, who had followed a 3-week supervised exercise re-training program within the last 6 months. Other inclusion criteria were: ability to use a bicycle for outdoor outings, weight
Results
All patients had completed initial curative chemotherapy, the majority had received prophylactic therapy against relapse and all had received follow-up and rehabilitation care (FRC). We included 14 women who were divided into 3 groups. All were included in the ITT analyzes, however, two stopped attending workshops before the end of the study, and participated in less than 6 outings on electric bikes. Thus, only 12 patients were included in the PP analyzes (Fig. 1). The characteristics of all
Discussion
This pilot study proposed an innovative approach based on a complete program of outings on electrically assisted bicycles and a health education program, performed outside the context of institutional health structures allowing a transition between a conventional rehabilitation program and the autonomy needed at the end of “active” medical care. The objectives of this study were to verify the feasibility of setting up such a program, to observe the changes in the amount of physical activity
Conclusion
Smart electrically assisted bicycle outings in small groups show promise as a means of encouraging breast cancer survivors to continue to pursue physical activity in the transition from rehabilitation to autonomy and normal everyday life. Indeed, the feasibility and adherence of participants to such a program was confirmed and the results on the evolution of physiological parameters showed an interesting magnitude of effect. The transition phase between supervised medical care and autonomy
Source of funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Ethics and regulatory requirements
The protocol received approval from the South Mediterranean Ethics Committee (Committee de Protection des Personnes, CPP) on September 13, 2017 and full authorization from the French National Commission for Informatics and Freedoms on October 17, 2017. The National Agency for the Safety of Medicines and Health Products (ANSM) was informed on August 28, 2017, and the protocol was registered on the clinical trial.gov website (NCT03340857).
Credit authorship contribution statement
Sophie Rey-Barth: Conceptualization, Writing – original draft. Nicolas Pinsault: Conceptualization, Supervision, Writing – original draft. Hugo Terrisse: Formal analysis, Visualization, Writing – review & editing. Claire Eychenne: Project administration, Investigation, Data curation, Writing – review & editing. Carole Rolland: Project administration, Investigation, Writing – review & editing. Alison Foote: Visualization, Writing – original draft, Writing – review & editing. Catherine Guyot:
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https://www.sciencedirect.com/science/article/abs/pii/S1350453322000091
