Abstract
Physical activity can help mitigate the long-term symptoms and side effects of cancer and its treatment, but most cancer survivors are not active enough to achieve these benefits. An evidence-based strategy to promote physical activity among adults is a community group–based walking program. However, many evidence-based programs do not achieve intended population health outcomes because of the challenges of real-world implementation. We used the Interactive Systems Framework for Dissemination and Implementation to conceptualize implementation of a capacity-building intervention to support delivery of a community group–based walking program. We adapted an evidence-based guide for community group–based walking programs for cancer survivors and their support network. We provided a capacity-building intervention (technical assistance and small-grant funding) and evaluated this implementation intervention. We assessed effectiveness of the intervention by measuring adoption, acceptability, appropriateness, feasibility, fidelity, implementation costs, and penetration through monthly progress reports, site visit observations, interviews, and a final report. Eight organizations received a small grant and technical assistance and implemented Step It Up! Survivors (SIUS). SIUS helped cancer survivors increase their physical activity, establish social connections, and be part of a supportive environment. Despite receiving monthly technical assistance, some grantees experienced challenges in recruiting participants, developing community partnerships, and adhering to the prescribed implementation plan. Implementation facilitators included community partners and specific components (eg, incentives for participants, webinars). Organizations needed different amounts and types of assistance with adaptation and implementation. Overall fidelity to SIUS ranged from 64% to 88%. Some integrated SIUS within existing organizational programming for sustainability. The provision of funding and technical assistance was a successful implementation intervention. Our results suggest a need to better tailor technical assistance while organizations are in the process of adapting, implementing, and sustaining an evidence-based program in their local communities.
Highlights
In 2019, approximately 16.9 million cancer survivors were living in the United States, and their number is estimated to increase to 22.1 million by 2030 [1]
The American Cancer Society recommends that cancer survivors engage in 150 minutes per week of moderate activity, such as brisk walking [4]
We identified the core elements of a walking program and its key characteristics to meet the needs of cancer survivors through a literature review
Summary
In 2019, approximately 16.9 million cancer survivors were living in the United States, and their number is estimated to increase to 22.1 million by 2030 [1]. Cancer survivors experience long-term symptoms and side effects of cancer and its treatment, including pain, fatigue, sleep disturbances, mood disturbances, reduction in quality of life [2], decreased physical functioning, and bone and muscle loss [3]. All text from this work may be reprinted freely. Use of these materials should be properly cited. The American Cancer Society recommends that cancer survivors engage in 150 minutes per week of moderate activity, such as brisk walking [4]. The American College of Sports Medicine indicates 90 minutes of moderate level activity mitigates symptoms and side effects of cancer and its treatment [5]. Less than half of cancer survivors are sufficiently physically active [6]
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