To evaluate the effectiveness of a group exercise-based cancer rehabilitation program delivered via telehealth compared to usual care for improving quality of life.
An assessor-blinded, pragmatic randomised controlled trial was conducted with adult cancer survivors. Participants were randomised to an 8-week, twice weekly, exercise group supervised via videoconferencing supplemented by an online home exercise program and information portal or usual care comprising standardised exercise advice. Assessments were completed at baseline (T0), post-intervention (T1) and follow-up (T2). The primary outcome was health-related quality of life (EORTC QLQ-C30) at T1. Secondary measures include walking capacity (6-minute walk test), physical activity (activPAL accelerometer), self-efficacy (Health Action Process Approach Questionnaire), adverse events and health service data. The primary outcome was analysed using linear mixed effects models and intention to treat principals. A per protocol analysis was performed with participants who adhered attendance at 50% or more sessions.
A total of 117 participants were recruited. One in four participants failed to attend any online exercise session. Adherence to online sessions was hampered by frequent non-attendance due to conflicting medical appointments and feeling unwell. Telerehabilitation was safe and no major adverse events occurred. Intention to treat analysis found no difference in outcomes between the experimental and control groups (EORTC-QLQ C30 MD -2.5 points (95% CI -6.6 to 1.7). Per protocol analysis found a small clinically significant effect for 6MWD but wide confidence intervals indicate uncertainty (MD 21.3m 95% CI-11.0 to 53.6).3.6).
An online group exercise telerehabilitation intervention was safe however, efficacy of the intervention was impacted by non-attendance and found not effective compared to usual care including standardised physical activity advice and assessment.
Despite the ability of telerehabilitation to reach more cancer survivors to exercise, it should not be the first-line exercise option for people with cancer. Telerehabilitation may be more suitable for people without access to in-person rehabilitation such as those in rural and remote areas or those with less barriers to exercise with good access to technology.
physical activity
telehealth
