Effectiveness of an Integrated Programme in Promoting the Regular Physical Activity Among Childhood Cancer Survivors
Condition: Malignant Childhood Neoplasm
MeSH terms: Neoplasms
Study type: Interventional

Summary: 
      Background.There is some evidence that engaging in regular moderate-intensity physical
      activity may help ameliorate cancer-related fatigue experienced by childhood cancer
      survivors, which eventually improve their quality of life. Nevertheless, there is growing
      concern about declining levels of physical activity in childhood cancer survivors.

      Purposes. To examine the effectiveness of an integrated adventure-based training and health
      education programme in promoting the adoption and maintenance of regular physical activity,
      reducing fatigue and improving the quality of life among Hong Kong Chinese childhood cancer
      survivors.

      Design and Subjects. A randomised controlled trial (RCT), two-group pre-test and repeated
      post-test, between subjects design was conducted. Recruitment of subjects was carried out
      through the Sunshine Parents Club, which is a non-profit voluntary organization with the aim
      to provide education and psychological support to parents of Hong Kong Chinese childhood
      cancer survivors.

      Intervention. Participants in the placebo control group received an amount of time and
      attention (leisure activities organized by a community centre) that mimicked that received by
      the experimental group. Participants in the experimental group joined a four-day integrated
      adventure-based training and health education programme, which contained education talks, a
      workshop and adventure-based training activities.
    

Detailed description: 
      The aim of this study was to examine the effectiveness of an integrated adventure-based
      training and health education programme in promoting the exercise behavior changes, enhancing
      the physical activity levels, self-efficacy, reducing fatigue and improving the quality of
      life of Hong Kong Chinese childhood cancer survivors.

      Intervention

      Placebo control group

      Participants received medical follow-up according to the schedule of the oncology units.
      Besides, participants received an amount of time and attention that mimicked that received by
      the experimental group, but which is thought not to have any specific effect on the outcome
      measures. They were invited to attend leisure activities organized by a community centre in
      four different days during the study period. Activities included cartoon film shows,
      handicraft workshops, chess games, health talks on the prevention of influenza and healthy
      diet, day visit to museum and theme park.

      Experimental group

      Besides receiving medical follow-up, participants joined a four-day integrated
      adventure-based training and health education programme, which contains education talks, a
      workshop to work out a feasible individual action plan for regular physical activity and
      adventure-based training activities. Previous research showed that working out individual
      action plan is important, which can increase the possibility for people to turn their
      intentions into health promotion action. The content of the education talks were tailor-made
      for participants in which they did not engage in regular physical activity.

      To ensure the dosage of intervention delivered in terms of the amount, frequency, duration,
      and breadth would be adequate to assess the quality and to manage outcomes, such as physical
      activity levels, self-efficacy, stages of change and quality of life, the following measures
      were taken. An advisory committee was set up with the purpose to develop an appropriate
      integrated programme for Hong Kong Chinese childhood cancer survivors. The committee included
      the researcher, an assistant professor at a local university with considerable experience of
      conducting psychological interventions among children, a paediatric oncologist and a oncology
      nurse specialist with rich experience in taking care of children with cancer, two
      professional adventure-based trainers and one assistant professor of Sports and Recreation
      Management with extensive experience and professional knowledge in conducting adventure-based
      training for children. In addition, the content of the programme that related to
      adventure-based training activities was sent to a professional adventure-based training
      centre for content validation. The programme was implemented on four different days within
      six months in a day camp training centre, such as at 2-week, 2-month, 4-month and 6-month
      after the day of recruitment. The programme was implemented in small group with maximum 12
      participants in one group. Health education talks and workshop were implemented in between
      adventure-based training activities in day camp centre, which were conducted by healthcare
      professionals working in a local university. Adventure-based training activities were led by
      two qualified adventure-based training instructors with extensive experience and professional
      knowledge in conducting such training for children. Additionally, at least two healthcare
      professionals joined the adventure-based training to monitor the physical condition of the
      survivors and their fitness to join the adventure-based training activities.

      Data Collection Methods

      Data Collection Methods Approval for the study was obtained from the hospital ethics
      committees. To identify potential subjects, a leaflet containing details of the study and a
      demographic sheet have been mailed to all parents of childhood cancer survivors in the
      Sunshine Parents Club. If children and their parents are interested in the research, they can
      return the demographic sheet by using the enclosed return-envelop to convey their willingness
      to participate in the study. A briefing session will then be conducted in the out-patient
      clinic to those eligible children and parents. Written consent has been obtained from the
      parents after they were told the purposes of the study, although they were of course given
      the option of allowing or refusing the involvement of their child. The children has also been
      invited to put their names on a special children's assent form and told that their
      participation is voluntary.

      After obtaining demographic data of participants, they have been asked to respond to the
      Chinese version of the FS-C/FS-A, PA-SE, CUHK-PARCY, PASCQ and PedsQL. They have also been
      assessed for muscle strength using a hand-held dynamometer. Participants have been randomly
      assigned to the experimental and control groups. All participants received a telephone call
      inviting them to join the interventions according to their group assignment at an appointed
      time. Data collection has been conducted again at 3, 6, 9 and 12 months after starting the
      intervention. All participants has been informed that there would be home visits for data
      collection.

      Analysis

      The Statistical Package for Social Sciences (SPSS) software, version 19.0 for Windows will be
      used to analyze quantitative data. Intention-to-treat analysis will be used and missing data
      will be substituted by the last-observation-carried-forward procedure. The comparability of
      the experimental and control groups will be assessed by using inferential statistics
      (independent t-test and chi-squared test). Descriptive statistics will be used to calculate
      the mean scores and standard deviation of different scales. Mixed between-within subjects
      ANOVA (split-plot ANOVA) will be used to determine whether the adventure-based training
      programme was effective in reducing fatigue, increasing childhood cancer survivors' levels of
      physical activity, self-efficacy and muscle strength and enhancing their quality of life. In
      addition, Friedman Test will be used to determine any changes in stages of change between the
      experimental and control groups.
    

Intervention name(s): health talk and adventure-based training; Placebo control
Intervention type(s): Behavioral; Behavioral
Intervention description(s): To develop an integrated programme for Hong Kong Chinese childhood cancer survivors, an advisory committee was set up which included the three healthcare professionals (researchers), two school principals, two professional adventure-based trainers and one assistant professor of Sports and Recreation Management, ensuring the adequate 'dosage' of the intervention and the feasibility of implementing such programme for Hong Kong childhood cancer surviviors.; They will be invited to attend leisure activities organized by a community centre in four different days during the study period. Activities will include cartoon film shows, handicraft workshops, chess games, health talks on the prevention of influenza and healthy diet, day visit to museum and theme park.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: Adventure-Based training; Health education; childhood cancer; physical activity