Beating cancer-related fatigue with the Untire mobile app:Results from a waiting-list randomized controlled trial

Objective: This waiting-list randomized controlled trial examined the effectiveness of a self-management mHealth app in improving fatigue and quality of life (QoL) in cancer patients and survivors. Methods: Persons with cancer-related fatigue (CRF) were recruited across four English speaking countries, via social media, and randomized into intervention (n = 519) and control (n = 280) groups. Whereas the intervention group received immediate access to the Untire app, the control group received access only after 12-weeks. Primary outcomes fatigue severity and interference, and secondary outcome QoL were assessed at baseline, 4, 8, and 12-weeks. We ran generalized linear mixed models for all outcomes to determine the effects of app access (yes/no), over 12-weeks, following the intention-to-treat principle. Results: Compared with the control group, the intervention group showed significantly larger improvements in fatigue severity (d = 0.40), fatigue interference (d = 0.35), and overall QoL on average (d = 0.32) (P's 56). Effects did not depend on education and cancer status. Reliable change analyses indicated that significantly more people showed full recovery for fatigue in the intervention vs the control group (P's =.02). Conclusions: The Untire app can be an effective mHealth solution for cancer patients and survivors with moderate to severe CRF

Lifestyle interventions in patients with a severe mental illness:Addressing self-management and living environment to improve health

The physical health of patients with a severe mental illness (SMI) is alarming and patients’ unhealthy lifestyle behaviors offer a window of opportunity to improve their health and well-being. In this thesis we studied how lifestyle behaviors in severe mentally ill patients could be improved in regular mental health care settings in order to improve their physical health. In the first pragmatic randomized controlled trial (ELIPS), lifestyle coaches trained residential staff members to target small changes in the obesogenic (obesity promoting) environment of residential patients with regard to diet and physical activity. We studied the effects on patients’ physical and mental health. The results showed that changing the obesogenic environment into a healthier environment could improve patients’ physical health and physical fitness. However, effects diminished when the lifestyle coaches left and staff members were responsible for the healthy environment. In the second trial (LION), we facilitated mental health nurses with training in motivational interviewing and a web tool to target lifestyle behaviors in SMI patients living at home. SMI patients, together with mental health nurses, screened their lifestyle behaviors and created a lifestyle plan with goals, which were biweekly discussed in regular care visits. This did not result in physical improvements, although patients’ motivation to change diet increased. The intervention was not cost-effective. Overall, this thesis indicates that lifestyle interventions for SMI patients are feasible in regular mental health care settings, but adaptations in mental healthcare routines are needed to enlarge and maintain outcomes