Novel Application of Recommendation Standards to Evaluate a Cancer-Specific Community-Based Exercise Program

Abstract

Physical activity (PA) is an important health behavior associated with improved physical functioning (1), well-being (1), and length of survival (2) for individuals living with and beyond cancer (i.e., survivors). However, after completion of active treatment, it has been reported that a large proportion of survivors do not meet established PA guidelines of ≥150 min of moderate-intensity PA per week (3,4). For many, treatment-related functional limitations persist months to years after treatment completion (5), and become barriers to initiate and maintain PA (1,3).Community-based supervised exercise programs (CSEP) specific to cancer survivors are growing in popularity and, when studied, have demonstrated feasibility and positive impacts on survivors' PA, muscular endurance, and well-being (6, 7). Oncology clinical practice guidelines recommend supervised exercise in the community or other outpatient settings (8), and leading organizations call for improved the integration of CSEP and oncology services (9). However, systematic and scoping reviews of existing CSEP show there is considerable variability in the reach, implementation, effectiveness, and sustainability of these programs (6,7,10). This variability in implementation and evaluation precludes the ability to ensure quality and to determine implementation strategies that may optimize effectiveness, participant satisfaction, and sustainability (10). Implementation and accreditation standards are critical to ensure safety, quality, and consistency of health care services (11). Thus, the field of exercise oncology is at a pivotal moment where the development and adoption of implementation and accreditation standards is necessary to optimize quality and consistency of CSEP.

A Group-Based, Videoconference-Delivered Physical Activity Program for Cancer Survivors

“…The current study also demonstrated statistically significant improvements in muscular endurance, as measured by the number of bicep-curl repetitions (with a 5-lb resistance band) and sit-to-stand repetitions completed in 30 s. This finding is consistent with a previous telehealth intervention for breast cancer survivors, which elicited large improvements in handgrip and sit-to-stand (16). The effect size observed for sit-to-stand repe-titions (d = 0.55) was smaller than observed following the faceto-face Fit Cancer program (d = 0.62) (21), similar to a study in breast and prostate cancer survivors that found smaller improvements in chair stand time when their in-person exercise intervention was adapted for videoconference delivery (20).…”

“…When compared with group-based videoconference PA interventions in other populations, increases in PA in the current study were larger: an average increase of 114.3 min•wk −1 of total MVPA in the current study versus 34.9 min of MVPA per week in a study of mothers (38), and 23.9 moderate PA minutes per week in a study of adults with Alzheimer's disease (39). It is difficult to ascertain the reason(s) for the larger increases in MVPA in our study compared with these two other studies; however, potential explanations could be the method of assessing PA (e.g., steps using an activity tracker vs self-reported aerobic and resistance exercise in the current study), population characteristics, Regarding QOL, two subscales (emotional and functional well-being) as well as total QOL showed a statistically significant increase, with small to medium effect sizes, which was similar to the face-to-face Fit Cancer program (21). One previous study also found that an 8-wk telehealth exercise intervention improved QOL with larger effect sizes than the current study; however, those participants were all postadjuvant treatment, and exercise sessions were held three times per week (16).…”

“…The program is offered two to three times per year and was delivered face-to-face from 2017 to 2020. Face-to-face program implementation and results have been previously described in detail (21). The primary goal of Fit Cancer is to empower cancer survivors to engage in independent PA by providing them with knowledge, tools, and skills during the program.…”