Physical Activity Monitoring Among Bone Marrow Transplant Patients: An Apple Watch Feasibility Trial

Background. We propose to develop and test the feasibility of an Apple Watch-based system that includes software to track physical activity and monitor patient-reported outcomes (PROs) among patients undergoing inpatient blood and marrow transplantation (BMT). After receiving BMT, patients’ immune system is significantly ablated, which requires them to stay at the hospital for an extended period of time. At this stage, patients are faced with severe physical and emotional distress due to treatment side effects, isolation and physical inactivity. The use of an Apple Watch-based system may offer an innovative and minimally-invasive approach to support healthy and safe physical activity during hospitalization. The potential benefits of the proposed system are many, including: (1) the potential to increase BMT patients’ physical activity levels via self-monitoring/individual feedback processes, which may lead to improved symptoms and better quality of life and (2) the technological advancement of these small but smart devices increases the likelihood of patients wearing and using these tools extensively, providing opportunities for real-time monitoring and intervention potential. Objective/Hypothesis. Following the NIH-supported stage framework for intervention development process, this work aims to examining the feasibility and acceptability of this approach to supporting physical activity within the inpatient BMT setting. Specific Aims. This project will apply user-centered design principles and rapidcycle prototyping methods to develop an Apple Watch-based system (Aim 1). After the initial prototype is refined in several iterative cycles, the final prototype will be tested in a small randomized controlled feasibility trial with 30 BMT patients between admission and 100-Day post-transplantation (Aim 2). Study Design. Primary end points include usability, acceptability, and feasibility. Secondary endpoints, including quality of life assessment and physical functioning, not for the purpose of evaluating efficacy in this small trial, but rather as methods of testing the feasibility of the evaluation measures and process to be included in the future large trial. Cancer Relevance. We expect that patients exposed to the Apple Watch-based system will report high usability, good acceptability, and ample usage, as well as feasibility and acceptability of the methods and measurements. A control condition will be employed to simulate the accrual process for a larger trial and identify challenges that might impact candidates’ willingness to submit to randomization. The results from this pilot study will enable us to pursue extramural funding opportunities that are available to support research that improves cancer patient outcomes using novel technological approaches. Although the proposed study is focused on hospitalized BMT patients, the study results, including the feasibility of an Apple Watch-based physical activity and PROs monitoring system, have a great potential to be generalizable to other cancers because we focus on solving the fundamental issues of physical inactivity and symptom management faced by many patients suffering