First-Year Implementation of the EXercise for Cancer to Enhance Living Well (EXCEL) Study: Building Networks to Support Rural and Remote Community Access to Exercise Oncology Resources

Abstract

Barriers to exercise-oncology programs remain for those living with and beyond cancer in rural and remote communities, including geographic isolation and access to programs. The EXercise for Cancer to Enhance Living Well (EXCEL) study was designed to support exercise-oncology implementation in rural and remote communities across Canada. The purpose of this analysis was to evaluate the first-year reach, adoption, and implementation of the EXCEL study. Reach outcomes included participant characteristics, study enrolment, and referral type (self vs. healthcare-provider [HCP] referral). Adoption outcomes included the number of clinical contacts, trained qualified exercise professionals (QEPs), and QEPs delivering EXCEL exercise classes. Implementation outcomes included retention, adherence, assessment completion rates, and adverse-event reporting. A total of 290 individuals living with cancer enrolled in EXCEL in year one, with an 81.4% retention to the study intervention. Most participants self-referred to EXCEL (75.8%). EXCEL’s HCP network consisted of 163 clinical contacts, and the QEP network included 45 trained QEPs, 22 of whom delivered EXCEL classes. Adherence to the exercise intervention was 78.2%, and only one adverse event (mild) was reported. Fitness assessment and patient-reported outcome completion rates were above 85% pre- and post-intervention. EXCEL has developed HCP and QEP networks supporting exercise referral and online delivery, and the intervention is meeting feasibility markers. These implementation findings will inform the continued gathering of feedback across stakeholders to ensure that best evidence informs best practices.

Scoping Review of Videoconference Online Exercise Programs for Cancer Survivors in Community Settings

“…All programs included cancer survivors at any stage of the cancer journey (i.e., no exclusions were made based on treatment status), and two programs reported the treatment statuses of participants, with 51.2% receiving chemotherapy during the program (22,30). Age and sex were reported by four programs (mean age, 54.2 ± 10.0 yr; 85.3% ± 20.0% female) (17,22,31,32). Sociodemographic information was reported by four programs, with participants predominantly being White (92.1% ± 5.2%) and highly educated (80.2% ± 9.1% had more than a college degree) (17,22,31,32).…”

“…No programs reported maintenance of outcomes after postprogram assessments. As yet, all programs appear that they will continue to be offered indefinitely (i.e., no end dates reported), offered exclusively via VOE (n = 7), or both VOE and in-person (n = 9) (Table 2) (17,22,(30)(31)(32)(33)35,38,39,42).…”

“…Retention (from before to after the program) was reported by four programs, with an average retention rate of 83.1% ± 7.4% (8,17,22,31). Four programs reported reasons for not completing the program, including changes in treatments and injuries that were not related to the program and/or VOE sessions (17,22,31,32).…”

“…Programs that were described in peer-reviewed publications (n = 4) were published between 2021 and 2023 and utilized single-arm pre-post designs (17,22,31,32). All programs identified through the MTC directory (n = 12) have been delivered using VOE since 2020.…”

“…with 51.2% receiving chemotherapy during the program (22,30). Age sex were reported by four programs (mean age, 54.2 ± 10.0 yr; 85.3% ± 20.0% female) (17,22,31,32). Sociodemographic information was reported by four programs, with participants predominantly being White (92.1% ± 5.2%) and highly educated (80.2% ± 9.1% had more than a college degree) (17,22,31,32).…”