A longitudinal implementation evaluation of a physical activity program for cancer survivors: LIVESTRONG® at the YMCA

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 LIVESTRONG® at the YMCA, a nationwide community-based PA program for cancer survivors delivered at Ys. Methods: This was a longitudinal study design using national LIVESTRONG at the YMCA data compiled between 2010 and 2018. Data is from all YMCAs who deliver LIVESTRONG at the YMCA, submitted by Program Directors to the YMCA-USA. We assessed reach (number of participants), adoption (associations offering the program), implementation (conducting 3 fidelity checks), and organizational level maintenance (associations recently offering program). We also examined relationships between organizational characteristics (years of program existence and association area household income) and program implementation factors with member conversion rates. Results: As of 2018, LIVESTRONG at the YMCA 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 LIVESTRONG session per year (organizational-level maintenance) and a facility-level mean membership conversion percentage of 46.9 ± 31.2%. Fewer years implementing the program and higher association area household income were significantly associated with a greater membership conversion rate vs their comparison. In a multiple regression model controlling for organizational characteristics, conducting the fidelity checks independently (observational, β = 8.41; goal-setting, β = 9.70; and functional, β = 9.61) and collectively (β = 10.82; 95% CI 5.90-16.80) was positively associated with higher membership conversion rates. Conclusions: LIVESTRONG at the YMCA, 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 membership conversion rate. Identification of association-level strategies to increase reach, adoption, implementation, and maintenance may increase the impact of this community-based PA program.

Experiences and perceptions of referrals to a community-based physical activity program for cancer survivors: a qualitative exploration

“…The research team was granted access to the master list of program directors contact information. In prior work, we identified sites located in both low and high household income areas based on a median of $47,300 [ 10 ]. Using these data, we purposefully sampled directors from branches in both low household ( n = 7) and in high household income areas ( n = 9) to ensure a representative sample by location.…”

“…This includes components of fitness (aerobic, strength, flexibility and balance) in addition to social support (positive support, active listening, shared storytelling) [ 9 ]. As of 2018, an estimated 62,000 people had completed the program at over 240 locations in 42 states [ 10 ]. Still, those who have completed LIVESTRONG at the Y represent a small fraction (0.004%) of the more than 17 million survivors nationwide [ 10 ].…”

“…As of 2018, an estimated 62,000 people had completed the program at over 240 locations in 42 states [ 10 ]. Still, those who have completed LIVESTRONG at the Y represent a small fraction (0.004%) of the more than 17 million survivors nationwide [ 10 ]. The most frequently reported method of hearing about the program from past participants was through referral from a doctor or other healthcare professional (27%) followed by word-of-mouth from a friend or family member (22%), followed by other reported sources [ 9 ].…”

Moving through cancer: Setting the agenda to make exercise standard in oncology practice

“…This would greatly expand the reach of exercise oncology programming that is appropriate for low‐risk patients. A national cancer exercise program, LIVESTRONG at the YMCA, has reached at least 62,044 survivors and 245 of the 840 Y associations (29%) 24 . Expansion of the community‐based LIVESTRONG at the YMCA program to include all YMCAs across the United States would allow exponentially more cancer survivors in the United States to have the opportunity to benefit from this popular and effective program 25 .…”

Experiences and perceptions of referrals to a community-based physical activity program from cancer survivors: A qualitative exploration

“…7Still, those who have completed the LIVESTRONG program represent a small fraction (0.004%) of the more 17 million survivors nationwide. (7) Most prior participants of the LIVESTRONG program reported hearing about the program through referral from a doctor or other healthcare professional (27%) followed by word-of-mouth from a friend or family member (22%). (8) Prior studies have reported that patients would like to hear about exercise from an exercise specialist at the cancer center, or from their oncologist.…”