1208 - The HEALTH4CLL study: optimization of behavioral interventions for patients with chronic lymphocytic leukemia

Introduction: Chronic lymphocytic leukemia (CLL) is the most prevalent leukemia in the United States, and advanced age and comorbidities increase the risk of cancer-related fatigue in patients with CLL. Exercise reduces fatigue, but optimal health behavior intervention methods for patients with CLL are unknown. We conducted a pilot study of digital diet and physical activity intervention tools (HEALTH4CLL) designed to reduce fatigue in patients with CLL.

Materials and

Methods: The HEALTH4CLL study used a randomized factorial design based on the multiphase optimization strategy (MOST). All patients received diet, exercise, and weight management instructional materials plus a Fitbit and were randomized to undergo one of sixteen combinations of four evidence-based intervention strategies over sixteen weeks: telephone versus email coaching, text message reminders versus no reminders, daily versus weekly self-monitoring, and aerobic plus resistance exercise versus aerobic exercise alone. Patients’ fatigue, physical function, health-related quality of life, behavioral changes, and program satisfaction and retention were assessed. Paired t-tests were used to examine changes in outcomes from baseline to follow-up among all patients. Factorial analysis of variance was used to examine effective intervention components and their combinations regarding improvement in fatigue and physical function scores.

Results: Thirty-one patients completed the interventions and follow-up assessment. We observed significant improvements in fatigue score (p=0.001), physical function score (p=0.01), sit to stand test results (p=0.046), arm curl test results (right, p=0.03; left, p=0.041), and grip strength (right, p=0.013; left, p=0.003) at follow-up. The combination of resistance and aerobic exercise with daily self-monitoring was associated with improved fatigue scores (p=0.027). Analysis of the individual components of the MOST design demonstrated greater improvement in the physical function score with resistance plus aerobic exercise than with aerobic exercise alone (p=0.048). We identified telephone coaching, text message reminders, and Fitbit use as feasible interventions.

Discussion: These findings demonstrated the feasibility and effectiveness of behavioral interventions in reducing fatigue and improving physical function in patients with CLL. Combined aerobic and resistance exercise, daily self-monitoring, and remote coaching were associated with improved physical function and reduced fatigue.