Trial Outcomes & Findings for Combined Technology Enhanced Home Exercise Program and Other Non-pharmacological Intervention for Cancer Survivors (NCT NCT03576274)

Last Updated: 2025-10-10

Results Overview

Fatigue will be measured by the self-report questionnaire including 1) the PROMIS-F, self self-report measure that assesses fatigue over the past 7 days. Score range 8-40 with higher score indicating worse fatigue.

Recruitment status

COMPLETED

Study phase

Target enrollment

110 participants

Primary outcome timeframe

Baseline and week 12 (post-intervention)

Results posted on

2025-10-10

Participant Flow

Participants were recruited from Johns Hopkins-affiliated hospitals (Sibley Memorial, Bayview, and JHH) and via social media, co-investigator referrals, and JHU-ICTR MyChart messages. Flyers and bookmarks directed potential participants to a REDCap screening survey. Recruitment included clinical settings and online platforms. Participants were contacted by the PI or research staff.

Participant milestones

Participant milestones
Measure	Technology Enhanced Home Exercise Only Participants in TEHE group will receive a combined technology and home exercise program. Participants will schedule an online meeting with the research team for exercise goal setting and preference. Participants will receive a daily symptoms survey. They will receive, reminder, motivation message and physical performance feedback though the mobile phone application. Technology Enhanced Home Exercise (TEHE): A 12 week program including one 60-minute goal setting and exercise training program and follow up phone calls.	Technology Enhanced Home Exercise Plus In additional to the TEHE program, participants will receive auricular point acupressure (APA) training on how to locate the ear points, place the seeds and apply the pressure on the seed. Participants will be instructed to press the tape and seeds covering each ear point for 3 minutes per time with a 2-second pause in between pressing, three times daily (morning, afternoon and evening: 9 minutes total). The tape and seeds will remain on ear points for 5 days. Participants will be instructed to remove both at the end of the 5th day. Technology Enhanced Home Exercise (TEHE): A 12 week program including one 60-minute goal setting and exercise training program and follow up phone calls. Auricular Point Acupressure (APA): A non invasive complementary method to provide pressure on the ear points.	Technology Enhanced Home Exercise-Mindfulness Intervention In addition to the TEHE program, the TEHE+MBI group will receive a audio-recording of a mindfulness-based body scan. During the weekly study visit: Participants will be instructed to listen to the recorded mindfulness-based body scan in the morning and before bedtime. At home: Participants will be asked to listen to this audiotape daily in the morning and before bedtime. Technology Enhanced Home Exercise (TEHE): A 12 week program including one 60-minute goal setting and exercise training program and follow up phone calls. Mindfulness body scan (MBI): The open, nonjudgmental attention to move one's attention calmly to the different part of the body	Control (Usual Care) The control group will receive instructions on how to use the physical activity tracker and mEMA application. Participants will be asked to meet with a research team member weekly to discuss their fatigue experience and receive general information about fatigue management.	Auricular Point Acupressure Only Participants will receive auricular point acupressure (APA) training on how to locate the ear points, place the seeds and apply the pressure on the seed. Participants will be instructed to press the tape and seeds covering each ear point for 3 minutes per time with a 2-second pause in between pressing, three times daily (morning, afternoon and evening: 9 minutes total). The tape and seeds will remain on ear points for 5 days. Participants will be instructed to remove both at the end of the 5th day. Auricular Point Acupressure (APA): A non invasive complementary method to provide pressure on the ear points.
Overall Study STARTED	22	23	21	22	22
Overall Study COMPLETED	14	18	16	13	13
Overall Study NOT COMPLETED	8	5	5	9	9

Reasons for withdrawal

Reasons for withdrawal
Measure	Technology Enhanced Home Exercise Only Participants in TEHE group will receive a combined technology and home exercise program. Participants will schedule an online meeting with the research team for exercise goal setting and preference. Participants will receive a daily symptoms survey. They will receive, reminder, motivation message and physical performance feedback though the mobile phone application. Technology Enhanced Home Exercise (TEHE): A 12 week program including one 60-minute goal setting and exercise training program and follow up phone calls.	Technology Enhanced Home Exercise Plus In additional to the TEHE program, participants will receive auricular point acupressure (APA) training on how to locate the ear points, place the seeds and apply the pressure on the seed. Participants will be instructed to press the tape and seeds covering each ear point for 3 minutes per time with a 2-second pause in between pressing, three times daily (morning, afternoon and evening: 9 minutes total). The tape and seeds will remain on ear points for 5 days. Participants will be instructed to remove both at the end of the 5th day. Technology Enhanced Home Exercise (TEHE): A 12 week program including one 60-minute goal setting and exercise training program and follow up phone calls. Auricular Point Acupressure (APA): A non invasive complementary method to provide pressure on the ear points.	Technology Enhanced Home Exercise-Mindfulness Intervention In addition to the TEHE program, the TEHE+MBI group will receive a audio-recording of a mindfulness-based body scan. During the weekly study visit: Participants will be instructed to listen to the recorded mindfulness-based body scan in the morning and before bedtime. At home: Participants will be asked to listen to this audiotape daily in the morning and before bedtime. Technology Enhanced Home Exercise (TEHE): A 12 week program including one 60-minute goal setting and exercise training program and follow up phone calls. Mindfulness body scan (MBI): The open, nonjudgmental attention to move one's attention calmly to the different part of the body	Control (Usual Care) The control group will receive instructions on how to use the physical activity tracker and mEMA application. Participants will be asked to meet with a research team member weekly to discuss their fatigue experience and receive general information about fatigue management.	Auricular Point Acupressure Only Participants will receive auricular point acupressure (APA) training on how to locate the ear points, place the seeds and apply the pressure on the seed. Participants will be instructed to press the tape and seeds covering each ear point for 3 minutes per time with a 2-second pause in between pressing, three times daily (morning, afternoon and evening: 9 minutes total). The tape and seeds will remain on ear points for 5 days. Participants will be instructed to remove both at the end of the 5th day. Auricular Point Acupressure (APA): A non invasive complementary method to provide pressure on the ear points.
Overall Study Lost to Follow-up	3	2	3	1	3
Overall Study Withdrawal by Subject	5	3	2	8	6

Baseline Characteristics

Combined Technology Enhanced Home Exercise Program and Other Non-pharmacological Intervention for Cancer Survivors

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure	Technology Enhanced Home Exercise Plus n=23 Participants In additional to the TEHE program, participants will receive auricular point acupressure (APA) training on how to locate the ear points, place the seeds and apply the pressure on the seed. Participants will be instructed to press the tape and seeds covering each ear point for 3 minutes per time with a 2-second pause in between pressing, three times daily (morning, afternoon and evening: 9 minutes total). The tape and seeds will remain on ear points for 5 days. Participants will be instructed to remove both at the end of the 5th day. Technology Enhanced Home Exercise (TEHE): A 12 week program including one 60-minute goal setting and exercise training program and follow up phone calls. Auricular Point Acupressure (APA): A non invasive complementary method to provide pressure on the ear points.	Technology Enhanced Home Exercise Only n=22 Participants Participants in TEHE group will receive a combined technology and home exercise program. Participants will schedule an online meeting with the research team for exercise goal setting and preference. Participants will receive a daily symptoms survey. They will receive, reminder, motivation message and physical performance feedback though the mobile phone application. Technology Enhanced Home Exercise (TEHE): A 12 week program including one 60-minute goal setting and exercise training program and follow up phone calls.	Technology Enhanced Home Exercise-Mindfulness Intervention n=21 Participants In addition to the TEHE program, the TEHE+MBI group will receive a audio-recording of a mindfulness-based body scan. During the weekly study visit: Participants will be instructed to listen to the recorded mindfulness-based body scan in the morning and before bedtime. At home: Participants will be asked to listen to this audiotape daily in the morning and before bedtime. Technology Enhanced Home Exercise (TEHE): A 12 week program including one 60-minute goal setting and exercise training program and follow up phone calls. Mindfulness body scan (MBI): The open, nonjudgmental attention to move one's attention calmly to the different part of the body	Control (Usual Care) n=22 Participants The control group will receive instructions on how to use the physical activity tracker and mEMA application. Participants will be asked to meet with a research team member weekly to discuss their fatigue experience and receive general information about fatigue management.	Auricular Point Acupressure Only n=22 Participants Participants will receive auricular point acupressure (APA) training on how to locate the ear points, place the seeds and apply the pressure on the seed. Participants will be instructed to press the tape and seeds covering each ear point for 3 minutes per time with a 2-second pause in between pressing, three times daily (morning, afternoon and evening: 9 minutes total). The tape and seeds will remain on ear points for 5 days. Participants will be instructed to remove both at the end of the 5th day. Auricular Point Acupressure (APA): A non invasive complementary method to provide pressure on the ear points.	Total n=110 Participants Total of all reporting groups
Age, Continuous	61 years STANDARD_DEVIATION 12 • n=7 Participants	59 years STANDARD_DEVIATION 12 • n=5 Participants	61 years STANDARD_DEVIATION 12 • n=5 Participants	60 years STANDARD_DEVIATION 13 • n=4 Participants	58 years STANDARD_DEVIATION 13 • n=21 Participants	60 years STANDARD_DEVIATION 12 • n=8 Participants
Sex/Gender, Customized Sex · Female	9 Participants n=7 Participants	9 Participants n=5 Participants	10 Participants n=5 Participants	9 Participants n=4 Participants	8 Participants n=21 Participants	45 Participants n=8 Participants
Sex/Gender, Customized Sex · Male	14 Participants n=7 Participants	12 Participants n=5 Participants	11 Participants n=5 Participants	13 Participants n=4 Participants	14 Participants n=21 Participants	64 Participants n=8 Participants
Sex/Gender, Customized Sex · Not reported	0 Participants n=7 Participants	1 Participants n=5 Participants	0 Participants n=5 Participants	0 Participants n=4 Participants	0 Participants n=21 Participants	1 Participants n=8 Participants
Ethnicity (NIH/OMB) Hispanic or Latino	1 Participants n=7 Participants	2 Participants n=5 Participants	2 Participants n=5 Participants	1 Participants n=4 Participants	2 Participants n=21 Participants	8 Participants n=8 Participants
Ethnicity (NIH/OMB) Not Hispanic or Latino	17 Participants n=7 Participants	16 Participants n=5 Participants	16 Participants n=5 Participants	19 Participants n=4 Participants	18 Participants n=21 Participants	86 Participants n=8 Participants
Ethnicity (NIH/OMB) Unknown or Not Reported	5 Participants n=7 Participants	4 Participants n=5 Participants	3 Participants n=5 Participants	2 Participants n=4 Participants	2 Participants n=21 Participants	16 Participants n=8 Participants
Race (NIH/OMB) American Indian or Alaska Native	0 Participants n=7 Participants	0 Participants n=5 Participants	0 Participants n=5 Participants	0 Participants n=4 Participants	0 Participants n=21 Participants	0 Participants n=8 Participants
Race (NIH/OMB) Asian	0 Participants n=7 Participants	1 Participants n=5 Participants	0 Participants n=5 Participants	1 Participants n=4 Participants	1 Participants n=21 Participants	3 Participants n=8 Participants
Race (NIH/OMB) Native Hawaiian or Other Pacific Islander	0 Participants n=7 Participants	1 Participants n=5 Participants	0 Participants n=5 Participants	0 Participants n=4 Participants	0 Participants n=21 Participants	1 Participants n=8 Participants
Race (NIH/OMB) Black or African American	2 Participants n=7 Participants	0 Participants n=5 Participants	1 Participants n=5 Participants	2 Participants n=4 Participants	1 Participants n=21 Participants	6 Participants n=8 Participants
Race (NIH/OMB) White	20 Participants n=7 Participants	18 Participants n=5 Participants	20 Participants n=5 Participants	18 Participants n=4 Participants	19 Participants n=21 Participants	95 Participants n=8 Participants
Race (NIH/OMB) More than one race	0 Participants n=7 Participants	0 Participants n=5 Participants	0 Participants n=5 Participants	0 Participants n=4 Participants	0 Participants n=21 Participants	0 Participants n=8 Participants
Race (NIH/OMB) Unknown or Not Reported	1 Participants n=7 Participants	2 Participants n=5 Participants	0 Participants n=5 Participants	1 Participants n=4 Participants	1 Participants n=21 Participants	5 Participants n=8 Participants
Education High school and below	1 Participants n=7 Participants	1 Participants n=5 Participants	1 Participants n=5 Participants	0 Participants n=4 Participants	0 Participants n=21 Participants	3 Participants n=8 Participants
Education Some college/associate degree	4 Participants n=7 Participants	1 Participants n=5 Participants	2 Participants n=5 Participants	8 Participants n=4 Participants	5 Participants n=21 Participants	20 Participants n=8 Participants
Education Bachelor's degree or higher	18 Participants n=7 Participants	19 Participants n=5 Participants	18 Participants n=5 Participants	11 Participants n=4 Participants	15 Participants n=21 Participants	81 Participants n=8 Participants
Education Not reported	0 Participants n=7 Participants	1 Participants n=5 Participants	0 Participants n=5 Participants	3 Participants n=4 Participants	2 Participants n=21 Participants	6 Participants n=8 Participants

PRIMARY outcome

Timeframe: Baseline and week 12 (post-intervention)

Population: Participants with data collected at both baseline and post-intervention are reported.

Outcome measures

Outcome measures
Measure	Technology Enhanced Home Exercise Only n=14 Participants Participants in TEHE group will receive a combined technology and home exercise program. Participants will schedule an online meeting with the research team for exercise goal setting and preference. Participants will receive a daily symptoms survey. They will receive, reminder, motivation message and physical performance feedback though the mobile phone application. Technology Enhanced Home Exercise (TEHE): A 12 week program including one 60-minute goal setting and exercise training program and follow up phone calls.	Technology Enhanced Home Exercise Plus n=18 Participants In additional to the TEHE program, participants will receive auricular point acupressure (APA) training on how to locate the ear points, place the seeds and apply the pressure on the seed. Participants will be instructed to press the tape and seeds covering each ear point for 3 minutes per time with a 2-second pause in between pressing, three times daily (morning, afternoon and evening: 9 minutes total). The tape and seeds will remain on ear points for 5 days. Participants will be instructed to remove both at the end of the 5th day. Technology Enhanced Home Exercise (TEHE): A 12 week program including one 60-minute goal setting and exercise training program and follow up phone calls. Auricular Point Acupressure (APA): A non invasive complementary method to provide pressure on the ear points.	Technology Enhanced Home Exercise-Mindfulness Intervention n=16 Participants In addition to the TEHE program, the TEHE+MBI group will receive a audio-recording of a mindfulness-based body scan. During the weekly study visit: Participants will be instructed to listen to the recorded mindfulness-based body scan in the morning and before bedtime. At home: Participants will be asked to listen to this audiotape daily in the morning and before bedtime. Technology Enhanced Home Exercise (TEHE): A 12 week program including one 60-minute goal setting and exercise training program and follow up phone calls. Mindfulness body scan (MBI): The open, nonjudgmental attention to move one's attention calmly to the different part of the body	Control (Usual Care) n=13 Participants The control group will receive instructions on how to use the physical activity tracker and mEMA application. Participants will be asked to meet with a research team member weekly to discuss their fatigue experience and receive general information about fatigue management.	Auricular Point Acupressure Only n=13 Participants Participants will receive auricular point acupressure (APA) training on how to locate the ear points, place the seeds and apply the pressure on the seed. Participants will be instructed to press the tape and seeds covering each ear point for 3 minutes per time with a 2-second pause in between pressing, three times daily (morning, afternoon and evening: 9 minutes total). The tape and seeds will remain on ear points for 5 days. Participants will be instructed to remove both at the end of the 5th day. Auricular Point Acupressure (APA): A non invasive complementary method to provide pressure on the ear points.
Change in Fatigue on the Patient-reported Outcomes Measure Information System (PROMIS-F) From Baseline to Week 12 (Post-intervention)	-3.8 score on a scale Standard Deviation 11.0	-7.9 score on a scale Standard Deviation 19.8	-5.8 score on a scale Standard Deviation 13.3	-3.2 score on a scale Standard Deviation 9.2	-3.3 score on a scale Standard Deviation 9.3

SECONDARY outcome

Timeframe: Baseline and week 12 (post-intervention)

Population: Participants with data collected at both baseline and post-intervention are reported.

Skeletal muscle strength was assessed by averaging the maximum force exerted across three trials for each hand using a hand-held dynamometer, with results recorded in pounds (lb).

Outcome measures

Outcome measures
Measure	Technology Enhanced Home Exercise Only n=3 Participants Participants in TEHE group will receive a combined technology and home exercise program. Participants will schedule an online meeting with the research team for exercise goal setting and preference. Participants will receive a daily symptoms survey. They will receive, reminder, motivation message and physical performance feedback though the mobile phone application. Technology Enhanced Home Exercise (TEHE): A 12 week program including one 60-minute goal setting and exercise training program and follow up phone calls.	Technology Enhanced Home Exercise Plus n=10 Participants In additional to the TEHE program, participants will receive auricular point acupressure (APA) training on how to locate the ear points, place the seeds and apply the pressure on the seed. Participants will be instructed to press the tape and seeds covering each ear point for 3 minutes per time with a 2-second pause in between pressing, three times daily (morning, afternoon and evening: 9 minutes total). The tape and seeds will remain on ear points for 5 days. Participants will be instructed to remove both at the end of the 5th day. Technology Enhanced Home Exercise (TEHE): A 12 week program including one 60-minute goal setting and exercise training program and follow up phone calls. Auricular Point Acupressure (APA): A non invasive complementary method to provide pressure on the ear points.	Technology Enhanced Home Exercise-Mindfulness Intervention n=3 Participants In addition to the TEHE program, the TEHE+MBI group will receive a audio-recording of a mindfulness-based body scan. During the weekly study visit: Participants will be instructed to listen to the recorded mindfulness-based body scan in the morning and before bedtime. At home: Participants will be asked to listen to this audiotape daily in the morning and before bedtime. Technology Enhanced Home Exercise (TEHE): A 12 week program including one 60-minute goal setting and exercise training program and follow up phone calls. Mindfulness body scan (MBI): The open, nonjudgmental attention to move one's attention calmly to the different part of the body	Control (Usual Care) n=3 Participants The control group will receive instructions on how to use the physical activity tracker and mEMA application. Participants will be asked to meet with a research team member weekly to discuss their fatigue experience and receive general information about fatigue management.	Auricular Point Acupressure Only n=4 Participants Participants will receive auricular point acupressure (APA) training on how to locate the ear points, place the seeds and apply the pressure on the seed. Participants will be instructed to press the tape and seeds covering each ear point for 3 minutes per time with a 2-second pause in between pressing, three times daily (morning, afternoon and evening: 9 minutes total). The tape and seeds will remain on ear points for 5 days. Participants will be instructed to remove both at the end of the 5th day. Auricular Point Acupressure (APA): A non invasive complementary method to provide pressure on the ear points.
Change in Right-hand Skeletal Muscle Strength, Measured Using a Hand-held Dynamometer, From Baseline to Week 12 (Post-intervention)	9.9 pounds (lb) Standard Error 33.2	-2.5 pounds (lb) Standard Error 10.2	2.8 pounds (lb) Standard Error 2.1	-3.1 pounds (lb) Standard Error 6.6	-0.4 pounds (lb) Standard Error 3.6

SECONDARY outcome

Timeframe: Baseline and week 12 (Post-intervention)

Population: Participants with data collected at both baseline and post-intervention are reported.

Skeletal muscle strength was assessed by averaging the maximum force exerted across three trials for each hand using a hand-held dynamometer, with results recorded in pounds (lb).

Outcome measures

Outcome measures
Measure	Technology Enhanced Home Exercise Only n=3 Participants Participants in TEHE group will receive a combined technology and home exercise program. Participants will schedule an online meeting with the research team for exercise goal setting and preference. Participants will receive a daily symptoms survey. They will receive, reminder, motivation message and physical performance feedback though the mobile phone application. Technology Enhanced Home Exercise (TEHE): A 12 week program including one 60-minute goal setting and exercise training program and follow up phone calls.	Technology Enhanced Home Exercise Plus n=10 Participants In additional to the TEHE program, participants will receive auricular point acupressure (APA) training on how to locate the ear points, place the seeds and apply the pressure on the seed. Participants will be instructed to press the tape and seeds covering each ear point for 3 minutes per time with a 2-second pause in between pressing, three times daily (morning, afternoon and evening: 9 minutes total). The tape and seeds will remain on ear points for 5 days. Participants will be instructed to remove both at the end of the 5th day. Technology Enhanced Home Exercise (TEHE): A 12 week program including one 60-minute goal setting and exercise training program and follow up phone calls. Auricular Point Acupressure (APA): A non invasive complementary method to provide pressure on the ear points.	Technology Enhanced Home Exercise-Mindfulness Intervention n=3 Participants In addition to the TEHE program, the TEHE+MBI group will receive a audio-recording of a mindfulness-based body scan. During the weekly study visit: Participants will be instructed to listen to the recorded mindfulness-based body scan in the morning and before bedtime. At home: Participants will be asked to listen to this audiotape daily in the morning and before bedtime. Technology Enhanced Home Exercise (TEHE): A 12 week program including one 60-minute goal setting and exercise training program and follow up phone calls. Mindfulness body scan (MBI): The open, nonjudgmental attention to move one's attention calmly to the different part of the body	Control (Usual Care) n=3 Participants The control group will receive instructions on how to use the physical activity tracker and mEMA application. Participants will be asked to meet with a research team member weekly to discuss their fatigue experience and receive general information about fatigue management.	Auricular Point Acupressure Only n=4 Participants Participants will receive auricular point acupressure (APA) training on how to locate the ear points, place the seeds and apply the pressure on the seed. Participants will be instructed to press the tape and seeds covering each ear point for 3 minutes per time with a 2-second pause in between pressing, three times daily (morning, afternoon and evening: 9 minutes total). The tape and seeds will remain on ear points for 5 days. Participants will be instructed to remove both at the end of the 5th day. Auricular Point Acupressure (APA): A non invasive complementary method to provide pressure on the ear points.
Change in Left-hand Skeletal Muscle Strength, Measured Using a Hand-held Dynamometer, From Baseline to Week 12 (Post-intervention)	4.4 pounds (lb) Standard Deviation 17.6	-0.7 pounds (lb) Standard Deviation 12.0	3.0 pounds (lb) Standard Deviation 1.3	-2.4 pounds (lb) Standard Deviation 11.6	19.8 pounds (lb) Standard Deviation 45.7

SECONDARY outcome

Timeframe: Between baseline and week 12 (post-intervention)

Peripheral venous blood was collected in serum tubes for plasma BDNF analysis both before and after the intervention. Plasma level of Brain Derived Neurotrophic Factors measured in ug/ml

Outcome measures

Outcome measures
Measure	Technology Enhanced Home Exercise Only n=22 Participants Participants in TEHE group will receive a combined technology and home exercise program. Participants will schedule an online meeting with the research team for exercise goal setting and preference. Participants will receive a daily symptoms survey. They will receive, reminder, motivation message and physical performance feedback though the mobile phone application. Technology Enhanced Home Exercise (TEHE): A 12 week program including one 60-minute goal setting and exercise training program and follow up phone calls.	Technology Enhanced Home Exercise Plus n=23 Participants In additional to the TEHE program, participants will receive auricular point acupressure (APA) training on how to locate the ear points, place the seeds and apply the pressure on the seed. Participants will be instructed to press the tape and seeds covering each ear point for 3 minutes per time with a 2-second pause in between pressing, three times daily (morning, afternoon and evening: 9 minutes total). The tape and seeds will remain on ear points for 5 days. Participants will be instructed to remove both at the end of the 5th day. Technology Enhanced Home Exercise (TEHE): A 12 week program including one 60-minute goal setting and exercise training program and follow up phone calls. Auricular Point Acupressure (APA): A non invasive complementary method to provide pressure on the ear points.	Technology Enhanced Home Exercise-Mindfulness Intervention n=21 Participants In addition to the TEHE program, the TEHE+MBI group will receive a audio-recording of a mindfulness-based body scan. During the weekly study visit: Participants will be instructed to listen to the recorded mindfulness-based body scan in the morning and before bedtime. At home: Participants will be asked to listen to this audiotape daily in the morning and before bedtime. Technology Enhanced Home Exercise (TEHE): A 12 week program including one 60-minute goal setting and exercise training program and follow up phone calls. Mindfulness body scan (MBI): The open, nonjudgmental attention to move one's attention calmly to the different part of the body	Control (Usual Care) n=22 Participants The control group will receive instructions on how to use the physical activity tracker and mEMA application. Participants will be asked to meet with a research team member weekly to discuss their fatigue experience and receive general information about fatigue management.	Auricular Point Acupressure Only n=22 Participants Participants will receive auricular point acupressure (APA) training on how to locate the ear points, place the seeds and apply the pressure on the seed. Participants will be instructed to press the tape and seeds covering each ear point for 3 minutes per time with a 2-second pause in between pressing, three times daily (morning, afternoon and evening: 9 minutes total). The tape and seeds will remain on ear points for 5 days. Participants will be instructed to remove both at the end of the 5th day. Auricular Point Acupressure (APA): A non invasive complementary method to provide pressure on the ear points.
Change in Brain Derived Neurotrophic Factors Between Baseline to Week 12 (Post-intervention)	-4945.7 ug/ml Standard Deviation 8777.9	-3971.3 ug/ml Standard Deviation 9551.5	-106.5 ug/ml Standard Deviation 1078.8	-2013.3 ug/ml Standard Deviation 5807	-2912.8 ug/ml Standard Deviation 13780

SECONDARY outcome

Timeframe: Baseline and week 12 (post-intervention)

Plasma level of Heat Shock Protein 90 (HSP90) measured in ug/ml from baseline to Week 12 (post-intervention)