Mates in Motion: Feasibility and Acceptability of a Couple-Based Physical Activity Intervention

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PROJECT SUMMARY Levels of physical activity (PA) among cancer survivors are low, yet PA may ameliorate difficult effects of treatment. We focus here on PA following the most intensive form of cancer treatment, hematopoietic cell transplantation (HCT). While potentially curative, the procedure is highly demanding, with multiple sequelae including chemotherapy- and radiation-induced cytopenia, and cardiovascular and pulmonary complications. PA is diminished post-transplant, and this decrease is associated with poorer physical functioning. Moderate exercise has been deemed safe for HCT patients, and PA interventions feasible. Findings regarding efficacy, however, are mixed, in part due to heterogeneity of intervention components and outcomes. The largest trial to date reported null findings but the exercise intervention was self-directed (arguably light) and PA was assessed via self-report. Findings from other studies suggest that PA may improve cardiorespiratory fitness, physical performance, and fatigue among HCT patients. All PA interventions in the HCT setting have focused entirely on patients, ignoring an opportunity to engage and benefit the family caregiver, a 24/7 role requiring the provision of medical and logistical support. Distress is common among HCT caregivers and their own health promotion is neglected. We aim to leverage the patient-caregiver relationship to improve PA among both patients and their caregiving spouses/partners. To do so, we will test feasibility and acceptability of a couple- based PA intervention developed for general cancer survivors and caregivers but translatable to HCT. Guided by social cognitive theory and interdependence/ communal coping perspectives, this intervention provides training in communication skills and joint problem-solving in the service of helping partners support one another in PA. We have adapted this protocol for the early post-HCT setting and will use Actigraph devices to monitor PA and inform weekly individualized step prescription. Specific aims are to: (1) Determine feasibility of recruitment [% of eligible couples agreeing to participate], adherence [% of intervention sessions attended, # valid Actigraph wear days, % therapeutic elements covered by therapist], and retention [% follow-up assessments completed] in a single-site pilot RCT. (2) Determine acceptability of the intervention among patients and caregivers (multiple dimensions of treatment satisfaction). (3) Describe patterns of change in PA and communal coping (intervention targets) for those in the intervention relative to usual care. Findings will inform the design of a full-scale RCT to test efficacy of the intervention to improve physical well-being, test mechanisms of action, and identify potential moderators of treatment response. Findings will also inform efforts to optimize the intervention for integration into standard transplant care, expanding providers' repertoire of supportive care options. More broadly, the intervention could be adapted for different types of patient-caregiver dyads and illness contexts.