The benefits of physical activity on managing chronic illnesses and multiple symptoms are well established. However, increasing the physical activity of persons living with multiple chronic conditions, especially low ? income cancer survivors with MCC, is challenging. Home-based exercise improves physical activity and symptoms among persons with single chronic disease but it is less clear in the context of multiple chronic conditions. One major challenge of home-based exercise is motivation and adherence. Mobile technologies (e.g., wearable device and smartphone application) have been used to improve motivation and monitor physical activity. Guided by the Society to Cells Framework and previous preliminary findings, Dr. Lukkahatai and colleagues developed a 12 week technology-enhanced home-based exercise program using a combination of integrated mobile technologies (wearable device and phone application) and tailored home based exercise. Participants will choose one of four home based exercise options (NIA Go4Life, Iyengar-style yoga, walking, and modified Otago exercise) based on their preference and goals. The integrated mobile technologies system will allow us to extract heart rate data directly from the wearable device to the research server. This data will be used to provide appropriate and personalized feedback on physical performance and trigger algorithms to send the survey and notification to the participants in real time. This pilot project will examine the feasibility of this technology-enhanced home exercise tailored to participants' goals and preferences. The brain derived neurotrophic factor (BDNF) has been identified as one of the resilience biomarkers. Exercise can change the BDNF level in serum. We found that cancer survivors who have low BDNF level experience increase fatigue during the treatment. Based on these previous findings, we will examine the effect of the program on fatigue, pain, AWB, resilience and BDNF level among low-income cancer survivors living with co-morbid conditions at completion (12 weeks) and 6 months in comparison to usual care waitlist group. As a secondary goal of this project, we will compare BDNF level in serum and sweat to explore a potential noninvasive method of measuring BDNF. The intervention will leverage the cancer survivorship phase (post-treatment) to motivate self-care by combining tailored existing evidence-based physical activity programs and mobile technology for participants to engage in resilience- enhancing physical activity. Identification of BDNF's role provides a novel target for an intervention and increase our understanding of the underlying mechanism of symptoms and resilience.
