TY  - JOUR
AU  - Tandon, Puneeta
AU  - Ismond, Kathleen P
AU  - Purdy, Graeme
AU  - Cruz, Christofer
AU  - Etruw, Evelyn
AU  - Suderman, Kirsten
AU  - Hyde, Ashley
AU  - Stickland, Michael
AU  - Spence, John C
AU  - Lien, Dale C
AU  - Bhanji, Rahima
AU  - Prado, Carla M
AU  - Miguel-Cruz, Antonio
AU  - Joy, Anil A
AU  - Yaskina, Maryna
AU  - McNeely, Margaret L
PY  - 2025
DA  - 2025/3/24
TI  - Acceptability and Effectiveness of a Fully Web-Based Nutrition and Exercise Program for Individuals With Chronic Disease During COVID-19: Randomized Controlled Trial
JO  - J Med Internet Res
SP  - e57537
VL  - 27
KW  - eHealth
KW  - patient-centered care
KW  - adults
KW  - geriatrics
KW  - self-management
KW  - web-based
KW  - nutrition
KW  - exercise rehabilitation
KW  - wearable
KW  - activity tracker
KW  - quality of life
KW  - physical health
KW  - 2-minute step test
KW  - patients with cancer
KW  - chronic diseases
KW  - COVID-19
KW  - randomized controlled trial
KW  - acceptability
KW  - effectiveness
KW  - intervention
AB  - Background: In-person nutrition and exercise interventions improve physical function in chronic diseases, yet the acceptability and effectiveness of web-based delivery, especially with different levels of personnel support, require further investigation. Objective: This study aims to evaluate a web-based nutrition and exercise intervention delivered entirely digitally from recruitment to trial completion. Methods: A randomized controlled trial was conducted using the Heal-Me version 1 platform across 2 levels of personnel support (Light and Intensive). Eligible adults with a history of cancer, chronic lung disease, or liver or lung transplant; internet access; and prior participation in a rehabilitation program were enrolled in a fully web-based program to minimize barriers to exercise participation. Participants were randomly assigned (1:1:1) to 1 of 3 study groups. The control group received a detailed, self-directed digital nutrition and exercise guide. The Heal-Me Light group received the web-based intervention alongside dietitian and exercise specialist–led group classes. The Heal-Me Intensive group received web-based intervention, group classes, and one-to-one sessions with the dietitians and exercise specialists. All participants received a wearable activity tracker. The primary acceptability outcome was adherence to the intervention based on a priori targets. The primary effectiveness outcome was the change in Lower Extremity Functional Scale (LEFS) score. Secondary outcomes included physical function tests, which were performed and measured by videoconference. Questionnaires were used to assess well-being, quality of life, and food intake. Analyses adhered to the intention-to-treat principle. Results: Of 216 participants, 202 (93.5%) completed the intervention (mean 61, SD 11 years; female: 130/202, 64.4%; cancer: 126/202, 62.4%). Adherence exceeded a priori targets, with 82% (105/128) attending >75% of the program elements including postintervention tests. Participants rated the program as “quite a bit” or “very” useful, with similar ratings between Heal-Me Light (56/64, 88%) and Heal-Me Intensive (51/58, 88%) groups (P=.69). No significant differences were found for changes in LEFS scores (control: mean 0.8, SD 7.7; Heal-Me: mean 0.3, SD 6.6; P=.53). Significant benefits were found in favor of the combined Heal-Me intervention groups versus controls for change in the 2-minute step test, World Health Organization-5 Well-Being Index, Short-Form-36 general, physical health role, energy or fatigue scales, and protein intake. While the change in physical function was similar between the 2 intervention arms, the more intensive one-to-one interaction (Heal-Me Intensive) led to greater improvements in perceived nutrition self-management. No serious adverse events occurred. Conclusions: The demonstrated satisfaction, adherence, and effectiveness highlight the high acceptability of a web-based, semisupervised nutrition and exercise intervention delivered entirely digitally in individuals with chronic disease. Future studies may benefit from having a baseline physical function inclusion threshold, the use of a more sensitive primary physical function measure, and a higher intensity digital exercise intervention in exercise-experienced participants. Trial Registration: Clinicaltrials.gov NCT04666558; https://clinicaltrials.gov/study/NCT04666558 International Registered Report Identifier (IRRID): RR2-10.1016/j.cct.2022.106791 
SN  - 1438-8871
UR  - https://www.jmir.org/2025/1/e57537
UR  - https://doi.org/10.2196/57537
UR  - http://www.ncbi.nlm.nih.gov/pubmed/40126542
DO  - 10.2196/57537
ID  - info:doi/10.2196/57537
ER  -