A Longitudinal Implementation Evaluation of a Physical Activity Program for Cancer Survivors: LIVESTRONG® at the Y.

Abstract

Purpose: Increased physical activity (PA) levels in cancer survivors are associated with decreased risk of recurrence and mortality as well as additional positive health outcomes. PA interventions have shown to be efficacious, though many lack translation to and sustainability in community settings. We used dimensions of the RE-AIM framework to evaluate LIVE STRONG® at the YMCA, a nation-wide community-based PA program for cancer survivors delivered at Ys. Methods: LIVE STRONG at the Y national data compiled by YMCA of the USA and Y Association Program Managers between the years of 2010-2018 was examined. We assessed reach (number of participants), adoption (Associations offering the program), implementation (conducting 3 fidelity checks), setting-level maintenance (Associations recently offering program) and participant-level maintenance (membership conversion rate). We also examined relationships between organizational characteristics (years of program existence and Association area household income), and program implementation factors with member conversion. Results: As of 2018, LIVE STRONG at the Y has reached 62,044 survivors and 245 of the 840 (29.2%) of Y Associations have adopted the program. Among the adopters, 91% were aware of fidelity checks; implementation of Observational (62.3%), Goal-setting (49.9%), and Functional (64.6%) checklists varied. Most (95.1%) adopters reported offering ≥1 LIVE STRONG session per year (setting-level maintenance) and a facility-level mean membership conversion percentage of 46.9±31.2% (participant-level maintenance). Fewer years implementing the program and higher Association area household income were significantly associated with a greater membership conversion rate vs their comparison (all t-test p’s <0.05). In a multiple regression model controlling for organizational characteristics, conducting the fidelity checks (Observational, β=8.41; Goal-setting, β=9.70; and Functional, β=9.61; all p’s <0.01) was positively associated with higher membership conversion rates. Conclusions: LIVE STRONG at the Y, in its early years, has shown promise for high reach, while adoption at more Associations could be facilitated. Implementing fidelity checks along with organizational characteristics were associated with higher participant-level maintenance. Identification of Association-level strategies to increase reach, adoption, implementation and maintenance may increase the impact of this community-based PA program.

Evaluation of a group‐based exercise and relaxation rehabilitation program during hospitalization for allogeneic hematopoietic stem cell transplant

“…RE-AIM is a planning and evaluation tool for the translation of research into practice explicitly focusing on the factors facilitating or impeding the successful implementation of real-world programs (described across the following domains: reach, effectiveness, adoption, implementation, and maintenance). 16 RE-AIM is the most widely used evaluation framework in public health research 17 and has been used to evaluate established inpatient [18][19][20][21] and community-based 22,23 interventions. In this study, we employed RE-AIM to comprehensively evaluate a group-based exercise and relaxation program for allo-HSCT inpatients at a cancer center.…”