A Mixed-Methods Evaluation of CARE (Cancer and Rehabilitation Exercise): A Physical Activity and Health Intervention, Delivered in a Community Football Trust

Abstract

With increasing cancer survivorship has come an increased necessity to support people living with cancer (PLWC) to have a good quality of life including being physically active. Using mixed methods, the current study aimed to use the RE-AIM evaluation framework (Reach, Effectiveness, Adoption, Implementation and Maintenance) to determine how the football community trust delivered CARE (Cancer and Rehabilitation Exercise) intervention was able to increase participants’ physical activity in order to improve their quality of life and regain physiological and psychological function. Quantitative outcome data were collected at baseline, 3 and 6 months using the Cancer Physical Activity Standard Evaluation Framework questionnaire. Semi-structured focus groups (n = 5) captured participants’ (n = 40) lived experience of the reach, effectiveness, adoption, implementation, and maintenance of CARE. Questionnaire data were analysed using repeated measures ANOVAs and qualitative data were thematically analysed. Following diagnosis, CARE was successful in providing participants with a unique and accessible opportunity to become or restart physically activity, by providing a local, socially supportive, and inclusive environment. This resulted in significant increases in physical activity (F(1.58, 23) = 5.98, p = 0.009), quality of life (QoL) (F(2,36) = 13.12, p = 0.000) and significant reductions in fatigue (F(1.57,31) = 11.19, p = 0.000) over 6 months. Participants also reported becoming more active, recovering physical function, regaining independence, and enhanced psychological well-being as a result of attending CARE. Key design features of CARE were also identified across RE-AIM. CARE, a football community trust delivered physical activity intervention was successful in significantly improving participants’ QoL and in regaining the physical and psychological functioning of people living with cancer. Results suggest that maintaining engagement in CARE for 6 months and beyond can support people to maintain these changes. Engaging in robust evaluations such as this can help organizations to successfully secure future funding for their programs.

An Investigation into the Physical Activity Experiences of People Living with and beyond Cancer during the COVID-19 Pandemic

“…The CARE programme is delivered by NCF, an established football community trust organisation with a proven track record in delivering successful community-based health improvement interventions [ 10 , 19 ]. As Rutherford and colleagues report, in response to local needs, ‘NCF, in partnership with Macmillan Cancer Support and informed by the Macmillan Physical Activity Behaviour Change Care Pathway; designed, funded, and established CARE in March 2015, for PLWBC across Nottinghamshire, England.…”

“…A recent scoping review of programme characteristics in community-based exercise programmes for people living with and beyond cancer (PLWBC) [ 16 ], identified interventions deploying football for the management of cancer, including prostate cancer [ 17 , 18 ]; however, no exercise programmes delivered by UK football club community foundations or trusts and aimed at supporting the PA participation of PLWBC were identified at that time [ 16 ]. More recently, Rutherford et al investigated the impact and implementation of the Cancer and Rehabilitation Exercise (CARE) programme delivered face-to-face by Notts County Foundation (NCF) [ 19 ]. They concluded that a football community trust, delivered PA cancer intervention, was successful in significantly improving participants’ quality of life and in regaining the physical and psychological functioning of PLWBC.…”

“…Rutherford’s study [ 19 ] took place before the advent of COVID-19, in 2020, which will be known for the emergence of the global pandemic caused by the spread of the COVID-19 virus [ 20 ]. In the UK on 23 March 2020, unprecedented legal restrictions were imposed by the UK Government to prevent the spread of the virus [ 21 ].…”

“…People considered as ‘clinically extremely vulnerable’ and especially suspectable to the contraction of the COVID-19 virus, also included some PLWBC and it has been suggested that based on available data, COVID-19 appears to affect people of all ages; however, those who are older and have pre-existing medical conditions, including cancer, may be at higher risk for serious medical complications [ 24 ]. PA participation is recommended throughout cancer therapy and survivorship [ 19 ], but the COVID-19 pandemic is expected to negatively impact on PA levels of PLWBC [ 25 ]. Moreover, it has also been suggested that non-face-to-face community support is urgently needed for adults facing reduced levels of PA and psychological hardships due to the COVID-19 pandemic [ 26 ].…”

“…The National Cancer Research Institute has identified research priorities which, in part, aim to establish the ‘best’ ways to support PLWBC to make lifestyle changes to improve their health’ [ 29 ]. Further, few studies have investigated the PA experiences of people attending PA interventions aimed at the management of cancer and specifically delivered through community football foundations [ 19 ], including those delivered during the COVID-19 pandemic and through periods of government restrictions. This issue is especially contemporary as COVID-19 government restrictions have been re-initiated in the UK and in parts of Europe in the Winter of 2021–2022 [ 30 ].…”