Delivering supervised group exercise to patients with cancer via telehealth: An implementation study using the RE-AIM framework

ABSTRACT

Aims: Assess the implementation of a telehealth supervised group exercise (tele-exercise) program for patients with cancer, using the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance). Method(s) Cancer patients with medical clearance and access to home internet participated in a physiotherapy-led tele-exercise program, comprising twice-weekly sessions for 12 weeks and featuring aerobic, resistance and balance exercises. A Garmin activity tracker was worn during sessions. Subjective (fatigue, quality of life) and objective (muscle strength, cardiorespiratory fitness, balance) measures were taken pre and post-program. Qualitative interviews (analysed using thematic and content analyses) and an online survey were completed post-program. Result(s) Reach Twenty-six eligible participants consented and were enrolled. Twenty-four commenced the program, most of whom were female (92%), diagnosed with breast cancer (75%), treated with surgery (96%), chemotherapy (88%) or radiation therapy (54%). Effectiveness FACIT-F scores indicated reduced fatigue (mean difference 5.8 [95% CI 1.9-9.8], p < 0.01). Improvements were seen across several strength, fitness and balance outcomes (e.g. upper body strength +5.6 [2.6-8.6] kg, p < 0.01). There were no changes to quality of life (FACT-G). Adoption Participants found classes easy to integrate into daily routines and felt it helped avoid negative aspects of in-person exercise (e.g. COVID-19 exposure, parking). Recruitment improved after introducing a 630 am class. Most (78%) participants felt very confident using the technology. Viewing heart rate via the Garmin device contributed to feeling safe whilst exercising. Implementation 21 of 24 participants completed the program. Mean number of sessions attended was 22. Maintenance Participants suggested feasible improvements to program orientation, discharge, and the exercise classes. All felt comfortable using the internet for tele-exercise. The majority considered a telehealth class as equal to an in-person class (15 of 18, 83%). Conclusion(s) A telehealth group exercise program for people with cancer was successfully implemented. Further information is needed regarding non-breast cancer patients and non-tertiary hospital settings.