Boost-UP Trial: Remote Behavior Change for Cancer

In a groundbreaking move towards enhancing the long-term health outcomes of individuals living with and beyond cancer (LWBC), researchers have launched an innovative randomized controlled trial to evaluate the added benefits of behavioral counseling alongside supervised physical activity. The study protocol, titled BOOST-UP-, is designed to be delivered entirely through virtual platforms, offering a streamlined and accessible avenue for cancer survivors to engage in sustained physical activity (PA).

Cancer survivorship often entails numerous physical and psychological challenges, including a noticeable decline in physical activity following structured exercise interventions. This decrease poses significant barriers to maintaining overall health and quality of life. Traditional short-term supervised programs, while effective in boosting immediate PA levels, have shown limited success in fostering sustained behavioral change. Recognizing this critical gap, the BOOST-UP- trial aims to interrogate whether the infusion of a motivationally-enhanced behavioral counseling program can yield superior and enduring engagement in moderate-to-vigorous physical activity (MVPA).

Conducted as a two-armed, multi-site randomized controlled trial, the study recruits a carefully stratified cohort of 236 participants living with or beyond cancer. Participants are randomized evenly into two intervention groups. One group receives a six-month virtual supervised PA regimen accompanied by standard exercise counseling (PA + EC), serving as the control arm. The counterpart group undergoes the identical PA intervention entwined with a strategically structured behavioral counseling program grounded in the Multi-Process Action Control (M-PAC) framework (PA + BC). This design balances both the exercise stimulus and counseling dosage while allowing researchers to isolate the impact of motivational enhancement.

The supervised PA sessions are delivered in real-time via synchronous Zoom classes, tailored to gradually transition participants toward a home-based exercise model as the intervention progresses. This tapering approach reinforces autonomy and self-management skills necessary for sustainable physical activity adherence. Both groups share the common objective of incrementally meeting or exceeding cancer-specific PA guidelines, particularly targeting 90 minutes of MVPA per week, a magnitude linked to improved health outcomes in cancer survivorship.

Behavioral counseling in the PA + BC cohort is implemented through twelve bi-weekly sessions conducted by qualified exercise professionals. These sessions delve into the M-PAC’s dimensions: reflective processes involving conscious evaluative considerations, regulatory processes that emphasize goal setting and self-monitoring, and reflexive processes that help integrate behaviors into habitual routines. This comprehensive framework aims to dismantle motivational barriers and facilitate stable, long-term PA initiation and maintenance.

Conversely, the control group receives twelve standard counseling sessions focused primarily on PA training principles but devoid of the layered motivational strategies inherent to the M-PAC-based counseling. This structure provides a robust attention control, mitigating potential confounding effects related to increased contact time and professional support, ensuring that any observed effects can be attributed to the behavioral counseling content.

The data collection spectrum is impressively comprehensive, incorporating multiple time points: baseline, midpoint, immediately post-intervention at six months, followed by six-month and one-year follow-ups. This longitudinal design affords an intricate view of both immediate and sustained changes in PA behaviors. SELf-reported metrics encompass quality of life assessments, motivational determinants aligned with the M-PAC model, health economic parameters, and participant satisfaction—all critical dimensions for evaluating holistic intervention impact and feasibility.

To fortify findings with objective evidence, participants wear accelerometers, yielding precise quantifications of PA intensity, duration, and frequency. The marriage of self-reported and objective data enables nuanced analyses, allowing researchers to cross-validate motivational shifts with actual behavioral changes. Advanced multilevel modeling techniques will dissect the trajectories of primary outcomes, chiefly physical activity levels, alongside secondary outcomes such as motivational mediators, physical functioning, and quality of life parameters.

The significance of this trial extends beyond its methodological rigor; it represents a shift towards telehealth-enabled behavioral medicine tailored for cancer survivorship. The virtual delivery mechanism accommodates geographical and logistical challenges common among this population, potentially democratizing access to high-quality behavioral and exercise support. If successful, this model can be rapidly scaled and integrated within clinical and community cancer care frameworks, enhancing survivorship care plans nationwide and globally.

A unique aspect of BOOST-UP- lies in its theoretical underpinning. Past exercise interventions often neglected comprehensive motivational theories, thus falling short in producing durable changes. By leveraging M-PAC, which synthesizes reflective evaluative goals, regulatory mechanisms, and reflexive habit formation, the study addresses the complex psychological architecture underpinning sustained PA adherence. Insights gleaned here could redefine best practices for behavioral interventions in oncology rehabilitation.

The importance of maintaining or increasing physical activity among LWBC cannot be overstated. Enhanced PA correlates consistently with reduced cancer recurrence risk, improved psychosocial outcomes, better physical functioning, and decreased comorbidities. Yet, translating these benefits into long-term adherence remains a challenge. BOOST-UP- represents a scientifically informed, patient-centered effort to bridge this translational gap, harnessing technology and behavioral science to deliver meaningful improvements at scale.

Another noteworthy element is the participatory approach, with exercise professionals trained extensively not only to supervise physical activity but also to deliver psychologically informed counseling sessions. This interdisciplinary model strengthens the synergy between exercise science and behavioral health, enhancing intervention fidelity and participant engagement. The bi-weekly frequency of counseling also sustains motivation arcs throughout the critical six-month period when decay of supervised exercise benefits tends to occur.

Moreover, by embedding measures of health economics, the trial provides policymakers and healthcare providers with actionable data on cost-effectiveness and resource allocation. Given the rising numbers of cancer survivors globally, scalable, low-cost interventions that effectively promote physical activity have the potential to alleviate long-term health system burdens. Such data are invaluable for justifying investment in integrative supportive care services.

The study’s investigator team hails from multiple institutions, ensuring diverse expertise and cross-institutional validation of findings. Their collaborative structure reflects increasing recognition that cancer survivorship care requires interdisciplinary cooperation, blending oncology, exercise physiology, psychology, and health services research.

The trial registration with ClinicalTrials.gov (ID NCT06624930) further underscores commitment to transparency and methodological excellence. This status facilitates peer oversight, fosters replication, and encourages dissemination upon completion. Early publication of the study protocol in a peer-reviewed platform like BMC Cancer signals rigorous scientific standards and enhances community confidence ahead of outcome reporting.

Anticipated outcomes from BOOST-UP- have the potential to inform clinical guidelines, health promotion policies, and community-based supportive care programming. Should the integration of behavioral counseling with supervised virtual physical activity prove superior in maintaining MVPA, it could become an evidence-backed model that transforms cancer survivorship care paradigms, making sustained physical activity an achievable standard of practice.

Ultimately, the BOOST-UP- trial embodies a sophisticated fusion of technology, behavioral science, and exercise medicine aimed at resolving a persistent clinical challenge: fostering long-term physical activity maintenance to improve overall survivorship health. It stands poised to contribute valuable knowledge with real-world applicability, empowering cancer survivors worldwide to harness physical activity for enhanced wellbeing and longevity.

Subject of Research: Physical activity maintenance and behavior change interventions among people living with and beyond cancer.

Article Title: A randomized controlled trial adding behavioral counseling to supervised physical activity in people living with and beyond cancer (BOOST-UP-): a study protocol for a live remotely-delivered behavior change intervention.

Article References:
Trinh, L., Rhodes, R.E., Alibhai, S.M.H. et al. A randomized controlled trial adding behavioral counseling to supervised physical activity in people living with and beyond cancer (BOOST-UP-): a study protocol for a live remotely-delivered behavior change intervention. BMC Cancer 25, 847 (2025). https://doi.org/10.1186/s12885-025-13904-8

Image Credits: Scienmag.com

DOI: https://doi.org/10.1186/s12885-025-13904-8

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