Implementing Exercise Rehabilitation into Clinical Practice for Individuals with Cancer
Creators: Suderman, Kirsten
Publisher: name: University of Alberta Library
Year: 2023

<p>The purpose of this dissertation was to explore, identify and address gaps in exercise oncology evidence-based care for individuals with cancer, with a specific focus on implementation of cancer-specific exercise programming. Further understanding is needed regarding the poor rates of reported physical activity by individuals with cancer, despite the robust evidence of benefits for exercise towards disease-related symptoms. A series of integrated knowledge translation (iKT) studies was conducted to identify (Study One, Two and Three) and address (Study Four) the barriers to implementation of exercise oncology evidence into practice. A further objective of this dissertation was to provide research evidence to guide implementation of exercise programming in community and clinical contexts. <br>
Study One, “Implementing Cancer Exercise Rehabilitation: An Update on Recommendations for Clinical Practice“, examined: (i) the state of the evidence supporting exercise for individuals with cancer; and (ii) guidelines for integrating exercise programming in the cancer clinical setting. Preliminary evidence supporting the implementation of community-based exercise programs was summarized, along with the principles and goals of exercise and identified barriers to exercise among individuals with cancer. Finally, an interdisciplinary model of care was proposed for integrating exercise programming into clinical care including guidelines for medical and pre-exercise screening, exercise testing and programming considerations.<br>
Studies Two and Three involved cross-sectional surveys and focus groups of individuals with cancer to identify and understand barriers and preferences towards accessing cancer-specific exercise programming. Study Two, “A Practical Approach to Using Integrated Knowledge Translation to Inform a Community-Based Exercise Study“, explored the needs of individuals with cancer prior to and following the Alberta Cancer Exercise (ACE-pilot) Feasibility Trial. Findings helped to inform implementation of a province wide cancer-specific, community-based exercise program: Alberta Cancer Exercise (ACE) Study. Participants identified a lack of exercise counselling and referral to local exercise programming by healthcare providers (HCPs). Study Three, “Virtual or In-Person: A Mixed Methods Survey to Determine Exercise Programming Preferences During COVID-19“, explored the barriers to oncology exercise that arose because of the coronavirus disease-19 (COVID-19) pandemic with the rapid need to pivot to virtual exercise programming, requiring use of technology and technological proficiency to access programming virtually. In the context of COVID-19, as technology emerged to allow better access to the virtual delivery of cancer-specific exercise programming, implementation strategies shifted from in-person to virtual exercise implementation. Survey findings showed that a majority of respondents were uncomfortable attending in-person exercise due to COVID-19 and had limited experience engaging in exercise virtually — highlighting the need for (i) alternative modes of exercise programming delivery to address concerns over COVID-19 exposure; and (ii) technology training to remove a primary barrier towards engaging in virtual exercise.<br>
Study Four, “Heal-Me Technology Counselling for eHealth (TeCH) study”, examined implementation of technology training to support virtual exercise programming for individuals with cancer, as well as individuals with other common chronic disease groups (chronic lung disease, and liver and lung transplant). The TeCH study addressed the previously identified barrier of technology and involved the provision of technology support through standardized one-on-one virtual orientations to the novel online Healthy Eating, Active Living, Mindful Energy (Heal-Me) Application. TeCH specifically examined the predictors of technology training time (TTT) required for chronic disease study participants to become proficient in using the Heal-Me Application to access multidisciplinary virtual exercise programming and nutrition support. Characteristics of age, self-rated technological proficiency scores, ethnicity and biological sex independently predicted technology training time: older aged participants, those self-identified as ethnic minorities and males were associated with higher TTT; higher self-rated technology proficiency scores were associated with shorter TTT. <br>
In conclusion, an iKT approach identified actionable strategies to address the needs of individuals with cancer related to exercise in clinical and community-based contexts. Study One highlighted the established evidence of the benefits of exercise towards cancer and the lack of evidence around effective implementation of community-based exercise programs. Study Two identified a specific knowledge-to-action gap regarding lack of exercise counselling and referral to exercise programming by HCPs in a clinical context. Study Three re-contextualized barriers to exercise programming during COVID-19, identifying technology as a barrier to accessing virtual community-based exercise programming. Study Four implemented technology counselling sessions to access care virtually and identified independent predictors towards TTT. </p>