Implementing an exercise oncology model to reach rural and remote individuals living with and beyond cancer: a hybrid effectiveness-implementation protocol for project EXCEL (EXercise for Cancer to Enhance Living Well)

Abstract

IntroductionIndividuals living with and beyond cancer from rural and remote areas lack accessibility to supportive cancer care resources compared with those in urban areas. Exercise is an evidence-based intervention that is a safe and effective supportive cancer care resource, improving physical fitness and function, well-being and quality of life. Thus, it is imperative that exercise oncology programs are accessible for all individuals living with cancer, regardless of geographical location. To improve accessibility to exercise oncology programs, we have designed the EXercise for Cancer to Enhance Living Well (EXCEL) study.Methods and analysisEXCEL is a hybrid effectiveness-implementation study. Exercise-based oncology knowledge from clinical exercise physiologists supports healthcare professionals and community-based qualified exercise professionals, facilitating exercise oncology education, referrals and programming. Recruitment began in September 2020 and will continue for 5 years with the goal to enroll ~1500 individuals from rural and remote areas. All tumour groups are eligible, and participants must be 18 years or older. Participants take part in a 12-week multimodal progressive exercise intervention currently being delivered online. The reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework is used to determine the impact of EXCEL at participant and institutional levels. Physical activity, functional fitness and patient-reported outcomes are assessed at baseline and 12-week time points of the EXCEL exercise intervention.Ethics and disseminationThe study was approved by the Health Research Ethics Board of Alberta. Our team will disseminate EXCEL information through quarterly newsletters to stakeholders, including participants, qualified exercise professionals, healthcare professionals and community networks. Ongoing outreach includes community presentations (eg, support groups, fitness companies) that provide study updates and exercise resources. Our team will publish manuscripts and present at conferences on EXCEL’s ongoing implementation efforts across the 5-year study.Trial registration numberNCT04478851.

The role of exercise for pain management in adults living with and beyond cancer: a systematic review and meta-analysis

“…One means of supporting access to evidence-based exercise programming is offering hybrid and/or virtual options which have grown since the start of the COVID-19 pandemic [119]. Virtual exercise that is supervised has been shown to be feasible and should be offered to the people living with cancer who are immunocompromised, have disabilities, have travel barriers, or for those living outside of urban centers where exercise oncology resources are usually located [120].…”

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

“…The present paper focuses on select RE-AIM implementation factors at baseline and twelve-week timepoints during the first year of implementation. Specific details regarding the entirety of the EXCEL protocol have been described previously [15]; it builds on the successful Alberta Cancer Exercise hybrid effectiveness-implementation study [18]. Ethics approval was received from the Health Research Ethics Board of Alberta (HREBA.CC-20-0098), as well as the respective hub ethics boards in Nova Scotia (Halifax) and Ontario (Toronto).…”

“…Implementation efforts for exercise-oncology resources targeting rural and remote individuals living with and beyond cancer must include QEP training, building program support and referrals from HCPs, and developing sustainable, community-based fitness partnerships [12]. The EXercise for Cancer to Enhance Living Well (EXCEL) effectiveness-implementation study [15] aims to build these networks with HCP and trained fitness professionals, utilizing a "Hub and Spoke Framework" (see Figure 1), to support sustainable implementation. This approach utilizes clinical exercise physiologists (CEPs) or registered kinesiologists in the "hub" urban centres to build both clinical and fitness networks (i.e., HCP and QEP networks) across rural and remote communities in the "spokes."…”

Designing for implementation: planning and evaluation of a clinical exercise oncology program

“…academic medical centers, urban vs rural hospital settings) to understand how to develop and deliver exercise oncology initiatives safely to all individuals with cancer. [10,16] The Midlands of South Carolina represents a unique model of cancer care to understand factors surrounding the implementation of exercise oncology interventions in community-based, private hospital settings. The majority of cancer care in the Midlands region is split between a large hospital system, Prisma Health -Midlands (PHM), (providing diagnostics and surgery) and a private cancer center, South Carolina Oncology Associates (SCOA) (providing chemotherapy, radiotherapy, hormone therapy, immunotherapy, and allied health services).…”

“…This is supported by the recognition that e cacy studies alone are insu cient to improve public health, and that strategies that identify barriers and facilitators of implementation in real-world settings are critical to moving research into practice. [4,[8][9][10][11][12] The study of dissemination and implementation of exercise oncology interventions/programs is a critical component for increasing our understanding on how to increase the access to care for people with cancer, and ultimately increase the number of individuals engaging in regular exercise. [4,[6][7][8] Implementation of interventions in real-world settings requires careful consideration of the intervention components (who delivers it, how are they trained, what is the structure, etc.…”