Feasibility of Implementing Cancer-Specific Community-Based Exercise Programming: A Multi-Centre Randomized Trial.

BACKGROUND: There is growing recognition of the importance of reporting preliminary work on the feasibility of a trial. The present study aimed to assess the feasibility of (1) a proposed fitness testing battery, and (2) processes related to the implementation of cancer-specific exercise programming in a community setting. METHODS/DESIGN: A randomized controlled implementation feasibility trial was performed in advance of a large-scale implementation study. Eligible participants within 18 months of a cancer diagnosis were randomized to immediate or delayed community-based exercise at YMCA locations in Calgary and Edmonton, Canada for an 8-week period. The primary outcome for the trial was the feasibility of the physical fitness testing battery, defined as a 70% or greater completion rate across the 24-week study period. The Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework was used to evaluate processes related to implementation of the exercise program across the two sites. RESULTS: Eighty participants were recruited, 73 (91%) completed the 8-week trial, and 68 (85%) completed the 16- and 24-week follow-ups. Sixty participants (75%) completed the full physical fitness test battery at each time point, and 59 (74%) completed the patient-reported outcome measures. Statistically significant between-group differences were found in favor of the exercise group for functional aerobic capacity, upper and lower extremity strength, and symptoms. Differences were found between the sites, however, in completion rates and processes related to program implementation. DISCUSSION: Findings suggest the need for minor adaptations to the physical fitness battery and outcome measures to better fit the community context. While findings support feasibility, context-specific challenges related to implementation processes were identified.

A Practical Approach to Using Integrated Knowledge Translation to Inform a Community-Based Exercise Study.

BACKGROUND: Our aim was to understand cancer survivor needs prior to, and following the Alberta Cancer Exercise (ACE) pilot randomized trial as a means to inform implementation of a province-wide cancer-specific, community-based exercise program. METHODS: Questionnaires and semi-structured stakeholder engagement sessions were conducted with cancer survivors to explore preferences, barriers and facilitators/benefits at two timepoints: (1) pre-ACE: prior to initiation of the ACE pilot trial (n = 13 survivors and n = 5 caregivers); and (2) post-ACE: following participation in the ACE pilot trial (n = 20 survivors). Descriptive statistics were used to summarize quantitative data from questionnaires. Stakeholder engagement data were analyzed using a framework analysis approach. Emergent themes were then mapped to actionable outcomes. RESULTS: Pre-ACE, survivors indicated a preference for exercise programs that were (1) supervised by exercise specialists knowledgeable about cancer, (2) included support from other health care providers, (3) were held in community locations that were easily accessible. Post-ACE, participants identified (1) a lack of exercise counseling from health care providers, (2) the need for earlier introduction of exercise in the care pathway, and (3) supported referral to exercise programming. CONCLUSIONS: An integrated knowledge translation approach identified actionable outcomes to address survivor needs related to exercise in clinical cancer and community-based contexts.

Benefits of 24 versus 12 weeks of exercise and wellness programming for women undergoing treatment for breast cancer.

PURPOSE: Community exercise programs can help maintain or improve health in cancer survivors. However, the most effective and feasible duration of a community exercise program for breast cancer survivors who are undergoing treatment is not known. This pre-post-design study evaluated the effects of the "Breast cancer patients Engaging in Activity while Undergoing Treatment" (BEAUTY) program on physical and psychosocial outcomes after 12 and 24 weeks. METHODS: BEAUTY is an ongoing community exercise and wellness program for breast cancer patients who are undergoing, or within 3 months of completing chemotherapy and radiation. Participants completed assessments at baseline, 12 weeks, and 24 weeks to measure body composition, hand-grip dynamometry, aerobic fitness, and flexibility. Self-report questionnaires assessed fatigue (FACIT-fatigue), cognitive function (FACT-cog), quality of life (QOL) (FACT-B), and depressive symptoms (CES-D). Main analyses were repeated measures general linear model for all outcomes. RESULTS: Assessments at all three time points were completed by N = 63 participants. At 24 weeks, waist to hip ratio (p = .019), duration of the submaximal treadmill test (p = .013), and estimated VO2max (p = .018) improved compared to baseline. Fatigue improved at 24 compared to 12 weeks (p = .002). FACT-B scores improved at 24 weeks when compared to both baseline (p = .002) and 12 weeks (p = .001). Depressive symptoms improved compared to baseline (p = .05) and 12 weeks (p = .009). CONCLUSIONS: Additional benefits were seen after 24 versus 12 weeks, suggesting that a longer duration exercise program during, or shortly after completing treatments for breast cancer, may be necessary to see improvements in fitness and psychosocial outcomes. Findings can be applied to community exercise and rehabilitation programs for breast cancer survivors.

The impact of physical activity on health-related fitness and quality of life for patients with head and neck cancer: a systematic review.

BACKGROUND: Patients with head and neck cancer often face a plethora of cancer and treatment-related side effects, negatively impacting their lean body mass, physical functioning, quality of life and fatigue management. Physical activity is a potential mediator of many of these side effects. This is the first systematic review reporting on head and neck cancer and physical activity literature. METHODS: A literature search was conducted up to January 2015. Two reviewers independently identified articles using the outlined inclusion criteria, assessing the study methodology, risk of bias and extracting the necessary data from studies evaluating the impact of full-body physical activity on patients with head and neck cancer. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement was used to guide this review. RESULTS: We identified 16 articles published from 2003 to 2014, the majority of which were published within the past 5 years. Physical activity interventions were feasible, safe and beneficial in mediating cancer and treatment-related side effects. Specifically, patients experienced improvements in lean body mass, muscular strength, physical functioning, quality of life and fatigue management. Owing to significant study heterogeneity, data were not pooled. Reflecting the early state of the literature, included studies were found to vary greatly in design, quality and reporting characteristics. CONCLUSIONS: There is early evidence that supports the benefit of physical activity interventions for patients with head and neck cancer, both during and following treatment. Future research is necessary to determine the benefits of different physical activity interventions, and their impact on patients with different head and neck cancers.

Evaluation of a Community-Based Exercise Program for Breast Cancer Patients Undergoing Treatment.

BACKGROUND: Exercise is important during treatment for breast cancer to alleviate the usual declines in physical and emotional health and overall health-related quality of life (HRQL). OBJECTIVE: This study evaluated the effectiveness, safety, and enjoyment of a community exercise program for breast cancer patients who were currently undergoing or within 3 months of completing chemotherapy or radiation treatment. METHODS: Breast cancer patients Engaging in Activity while Undergoing Treatment (BEAUTY) is a 12-week program of resistance, aerobic, and flexibility exercise. Participants completed pre and post fitness assessments, and questionnaires to measure HRQL, fatigue, cognitive function, and depressive symptoms. Participants had access to group exercise classes and were provided a home-based exercise program. RESULTS: Participants (n = 80) were middle aged (mean age, 50.3 [SD, 9.0] years), and the majority were diagnosed with stage II breast cancer (53.8%). From baseline to 12 weeks, resting heart rate (mean [INCREMENT], +4.15 beats/min) and body mass index increased slightly (mean [INCREMENT], +0.47 kg/m). No clinically significant changes in HRQL or other psychosocial questionnaires, but social well-being decreased (t77 = 3.83, P = .000) slightly, and emotional well-being improved (t77 = -2.15, P = .034). Participants attended an average of 7.5 (SD, 6.5) classes; feedback about the program was positive, and no exercise-related injuries were reported. CONCLUSIONS: The BEAUTY program was feasible and effective in managing chemotherapy and radiation treatment-related declines in physical fitness and HRQL. IMPLICATIONS FOR PRACTICE: This study supports the need to integrate exercise programming as part of treatment plans for breast cancer patients.