SG’s first smartphone-based cancer prehab program sees early success

A smartphone-based cancer prehabilitation program in Singapore is feasible and safe, with preliminary data showing high acceptability among local users.

Called the cancer prehabilitation exercise diary, the program was developed to provide a platform for patients to engage with their prescribed exercise routines. A library of instructional videos, selected and customized by a physiatrist, provides clear guidance for each exercise. The exercise diary also includes features designed to support patient adherence, such as personalized reminders, exercise logs, and progress tracking.

The program is integrated into Singapore’s existing healthcare mobile app, Health Buddy. Researchers from the Changi General Hospital believe that such an approach may help address the challenges faced by many cancer patients, particularly those who are sedentary or older, by providing a convenient and engaging way to perform their exercises correctly and consistently.

In a pilot study, app users demonstrated high compliance (80 percent), defined as completion of prescribed exercises and the accuracy of executing them. [JMIR Form Res 2025:9:e64427]

Satisfaction survey data indicated high overall satisfaction with the app, with over 90 percent of respondents reporting favourably on ease of use, technical reliability, and overall satisfaction. Most users indicated a willingness to recommend the app to others. Positive experiences with the clarity of exercise instructions and the ability to successfully perform the exercises were also reported.

A total of 63 patients with newly diagnosed gastrointestinal and urological cancers awaiting surgery were included in the study. Of these, 41 patients were prescribed the app and 22 were not due to various reasons, including lack of a smartphone or data plan, short duration to the operation, and hearing impairment, among others.

In the subgroup of patients who were prescribed the app, 25 were users (mean age 69 years, 60 percent male, 84 percent Chinese) and 16 were nonusers (mean age 67 years, 87.5 percent male, 87.5 percent Chinese).

In terms of efficacy, no significant differences between the app users and nonusers were observed for preoperative functional improvements (6-minute walk test [6MWT]: p=0.60; 30-second sit-to-stand test [STS]: p=0.81; timed up and go test [TUG]: p=0.53; Hospital Anxiety and Depression Scale [HADS]: p=0.36). The same was true for patients who were prescribed vs those not prescribed the app (6MWT: p=0.94; STS: p=0.26; TUG: p=0.39; HADS: p=0.62). Baseline measures indicated significantly lower functional scores and higher mean frailty scores in the nonprescribed vs prescribed group.

Benefits of prehabilitation

“Cancer prehabilitation is defined as a set of interventions delivered within the cancer care continuum, occurring during the period between diagnosis and the initiation of definitive treatment. It encompasses baseline assessments of physical function, nutritional status, and psychological well-being,” the researchers said.

“Prehabilitation also involves the identification of potential impairments and the implementation of targeted interventions aimed at optimizing health, thereby reducing the risk and severity of future treatment-related complications,” they added.

The efficacy of cancer prehabilitation programs has been shown in international reviews and meta-analyses. And the findings of the pilot study, with 90 percent of postintervention survey respondents reporting satisfaction with the app and a willingness to recommend it to others, suggest promise for the app’s use among cancer patients receptive to technology-enabled healthcare interventions, according to the researchers. [J Cancer Surviv 2018;12:64-73; Arch Rehabil Res Clin Transl 2022;4:100236; Ann Surg 2021;274:70-77]

“Lower baseline functional outcome measures and a higher mean frailty score in the unprescribed group have implications for the selection process and patient participation,” they noted.

Future research efforts should examine strategies to enhance readiness for technology, sustainability, and effectiveness in older patients, the researchers said.