DELIVERING SUPERVISED GROUP EXERCISE TO PATIENTS WITH CANCER VIA TELEHEALTH: AN IMPLEMENTATION STUDY USING THE REAIM FRAMEWORK

E.M. Gane^1,2, J. Tan¹, E.C. Ward^2,3, R.J. Chan⁴, M.B. Pinkham⁵, N.H. Hart⁴, J. Williames¹, E. Pinkham¹

¹Princess Alexandra Hospital, Physiotherapy, Brisbane, Australia, ²The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Australia, ³Metro South Health, Centre for Functioning and Health Research, Brisbane, Australia, ⁴Flinders University, Caring Futures Institute, Adelaide, Australia, ⁵Princess Alexandra Hospital, Radiation Oncology, Brisbane, Australia

Background: There is now a robust evidence base that demonstrates that exercise can help counteract some of the side effects of cancer and its associated treatments, such as fatigue and reduced physical function. These can all be improved with individually prescribed, moderate-intensity aerobic and resistance exercise. Barriers exist that impact patients’ ability to access in-person supervised exercise programs. Telehealth is a model of care that can be used to effectively and safely deliver exercise to clinical populations. However, there are challenges to implementing changes to clinical service models such as a shift from in-person to telehealth that warrant particular exploration.

Purpose: 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).

Methods: 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. Sessions were delivered via Microsoft Teams. A Garmin activity tracker was worn during sessions for monitoring of heart rate and pulse oximetry. 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.

Results: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 +6.8 [95% CI 3.2-10.4], p<0.01). The Functional well-being sub scale of the FACT-G quality of life measure improved (+1.9 [0.05-3.7], p<0.05). Improvements were seen across several balance outcomes as well as upper body strength (+5.4 [2.3-8.6] kg, p<0.01) and Six Minute Walk Test distance for cardiorespiratory fitness (+55 [28-81] m, p<0.001). 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, travel). Recruitment improved after introducing a 6:30am 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%).

Conclusions: 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.

Implications: Cancer patients who engage in a tele-exercise program feel safe when exercising with remote physiotherapy supervision and receive the benefits of exercise for cancer-related side effects (improved strength, fitness, quality of life, fatigue). Physiotherapists should consider using tele-exercise to overcome barriers to accessing supervised exercise for cancer patients.

Funding acknowledgements: This study was funded by the PA Research Foundation (https://www.pafoundation.org.au/).

Keywords:
Cancer rehabilitation
Telehealth
Implementation science

Topics:
Oncology, HIV & palliative care
Research methodology, knowledge translation & implementation science
Non-communicable diseases (NCDs) & risk factors

Did this work require ethics approval? Yes

Institution: Metro South Health

Committee: Metro South Human Research Ethics Committee

Ethics number: HREC/2021/QMS/72886