Community-based Exercise For Health Promotion And Secondary Cancer Prevention: A Hybrid Effectiveness-implementation Study

Abstract

PURPOSE: Cancer care has expanded from a disease-focused, survival-oriented model to an approach that now considers how survivors can live well in the aftermath of intensive therapy. Research evidence supports the benefit of exercise during and following cancer treatments for cancer-related symptoms, physical fitness, and health-related quality of life. To move efficacy evidence into practice, we designed and launched the Alberta Cancer Exercise (ACE) program, a 5-year study to evaluate the relative benefit from implementing a clinic-to-community-based exercise and cancer model of care. METHODS: A hybrid effectiveness and implementation trial design is evaluating the effectiveness of community-based exercise, and collecting data on implementation of the program. ACE opened in January 2017 and is now offered across seven cities (18 sites) in Alberta, Canada. Participants are adult survivors from all tumour groups and stages, at any time point since diagnosis, up to 3 years post treatment completion. Survivors take part in a minimum of 60 minutes of mild-to-moderate intensity full body exercise twice weekly for a 12-week period. The primary effectiveness outcome is the proportion of participants meeting physical activity guidelines at 1-year follow-up. The Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework is being used to capture individual-level and organizational-level impact of ACE. RESULTS: 1506 Albertan survivors have entered ACE and 1109 have completed the 12-week intervention. Completion rates for 12, 24 and 1-year follow-ups are 91%, 84% and 79% respectively. Post-intervention, statistically significant benefits were found for fitness and patient-reported outcomes such as the 6 minute-walk test distance (+36m; p <0.001), lower leg strength (+34 lbs; p <0.001) and symptoms of fatigue (+2.56 points; p <0.01). Of the 631 participants who have completed the 1-year follow-up, the number of participants meeting 150 minutes of moderate intensity exercise per week increased from 28.4% to 35.5% (p <0.01). CONCLUSIONS: Results support high interest in, and benefit from ACE among Albertan survivors. While statistically and clinically significant benefits were found short-term, further efforts are needed to support long-term exercise behaviour change.