Designing For Integration: Planning And Evaluation Of A Clinical Exercise Oncology Program

PURPOSE: Research suggests that exercise has beneficial effects on a variety of cancer related health outcomes. However, effectively implemented exercise programs for individuals with cancer are lacking. The aim of this project was to design and evaluate an exercise program for the Midlands oncology community. METHODS: This study was completed in two phases 1) pre-integration and 2) evaluation. A stakeholder advisory group that included partners from the university and hospital systems was formed to guide the project. During the pre-integration phase, healthcare personnel were interviewed to determine program delivery and referral management. This resulted in the design and execution of an 8-week (twice per week) aerobic and resistance exercise program that ran 3 times over the course of 10 months. Outcomes included the Bellarmine Norton Assessment Tool (BNAT) consisting of the 2-minute step test, 30-second sit to stand, 30-second arm curl and timed up and go as well as fatigue assessed using the FACIT fatigue scale. RESULTS: The pre-integration phase determined the participant referral process and the location/delivery of the program. Specifically, 4 points of interaction were identified as opportunities for referrals (chemotherapy education nurses, primary nurse practitioners, offboarding services and rehabilitation service referral). Further, it was decided to leverage existing rehabilitation facilities to deliver the exercise program, which informed days per week (2), times of offering (6:30 am-7:30 am and 5:30 pm-6:30 pm), and outcomes assessed. Participants experienced significant improvements in cancer-related fatigue (pre: 43.0 ± 9.45, post: 38.00 ± 11.34, p < 0.05), 2-minute step test (pre: 74.54 ± 19.29, post: 88.79 ± 11.34, p < 0.05), 30-second sit to stand (pre: 10.71 ± 4.19, post:12.54 ± 5.66, p < 0.05), 30-second arm curl(pre: 13.20 ± 3.43, post:15.88 ± 5.45, p < 0.05) and timed up and go(pre: 8.04 ± 3.49, post:6.38 ± 2.4, p < 0.05). CONCLUSION: The effectiveness of an exercise program for individuals with cancer was supported by statistically significant improvements in physical function and fatigue. Preplanning with healthcare system stakeholders provided input to facilitate referrals and delivery of the program. Future programs aiming for integration should consider this approach.