UMMS Affiliation

Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences; Division of Preventive Behavioral Medicine, Department of Population and Quantitative Health Sciences; Biostatistics and Health Services Research, Department of Population and Quantitative Health Sciences; Graduate School of Biomedical Sciences

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Health Information Technology | Health Psychology | Infectious Disease | Mental and Social Health | Neoplasms | Oncology | Psychiatry and Psychology | Virus Diseases


BACKGROUND: COVID-19 has had significant health-related and behavioral impacts worldwide. Cancer survivors (hereafter referred to as "survivors") are particularly prone to behavioral changes and are encouraged to be more vigilant and observe stricter social distancing measures.

OBJECTIVE: We explored (1) changes in physical activity and sedentary behaviors since the onset of COVID-19, along with changes in mental health status, and (2) alternative strategies to support survivors' physical activity and social health during and after COVID-19, along with the role of digital health in such strategies.

METHODS: A questionnaire was distributed among survivors participating (currently or previously) in the community-based physical activity program LIVESTRONG at the Young Men's Christian Association (YMCA), from 3 sites outside an urban area in Massachusetts. Questions addressed pre-COVID-19 vs current changes in physical activity and sedentary behavior. Anxiety and depression were assessed using the 2-item Generalized Anxiety Disorder scale (GAD-2) and 2-item Patient Health Questionnaire (PHQ-2), and scores > /=3 indicated a clinical diagnosis of anxiety or depression, respectively. Digital health preferences were assessed through closed-ended questions. Open-ended responses addressing other preferences for physical activity programs and social support were analyzed, coded, and categorized into themes.

RESULTS: Among 61 participants (mean age 62 [SD 10.4] years; females: 51/61 [83.6%]), 67.2% (n=41) reported decreased physical activity and 67.2% (n=41) reported prolonged sitting times since the onset of COVID-19. Further, 24.6% (n=15) and 26.2% (n=16) met the GAD-2 and PHQ-2 criteria for clinical anxiety and depression, respectively. All participants owned a cellphone; 90% (n=54) owned a smartphone. Preferences for physical activity programs (n=28) included three themes: (1) use of digital or remote platforms (Zoom, other online platforms, and video platforms), (2) specific activities and locations (eg, outdoor activities, walking, gardening, biking, and physical activities at the YMCA and at senior centers), and (3) importance of social support regardless of activity type (eg, time spent with family, friends, peers, or coaches). The survey revealed a mean score of 71.8 (SD 21.4; scale 0-100) for the importance of social support during physical activity programs. Social support preferences (n=15) revealed three themes: (1) support through remote platforms (eg, texting, Zoom, phone calls, emails, and Facebook), (2) tangible in-person support (YMCA and senior centers), and (3) social support with no specific platform (eg, small gatherings and family or friend visits).

CONCLUSIONS: Physical activity and mental health are critical factors for the quality of life of survivors, and interventions tailored to their activity preferences are necessary. Digital or remote physical activity programs with added social support may help address the ongoing needs of survivors during and after the pandemic. Wang, Sarah L Cutrona, Rajani S Sadasivam. Originally published in JMIR Cancer (, 03.02.2021.


COVID-19, cancer, digital, physical activity, support, technology

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© Jamie M Faro, Kristin M Mattocks, Catherine S Nagawa, Stephenie C Lemon, Bo Wang, Sarah L Cutrona, Rajani S Sadasivam. Originally published in JMIR Cancer (, 03.02.2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Cancer, is properly cited. The complete bibliographic information, a link to the original publication on, as well as this copyright and license information must be included.

DOI of Published Version



Faro JM, Mattocks KM, Nagawa CS, Lemon SC, Wang B, Cutrona SL, Sadasivam RS. Physical Activity, Mental Health, and Technology Preferences to Support Cancer Survivors During the COVID-19 Pandemic: Cross-sectional Study. JMIR Cancer. 2021 Feb 3;7(1):e25317. doi: 10.2196/25317. PMID: 33471776; PMCID: PMC7860926. Link to article on publisher's site

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JMIR cancer

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Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.