Feasibility and preliminary efficacy of a novel telehealth exercise program for rural cancer survivors with cancer-related fatigue: A pilot study (Preprint)

UNSTRUCTURED Background: Exercise interventions are among the best-known interventions for cancer-related fatigue (CRF). Rural cancer survivors, however, report specific barriers to engaging in exercise programs and lack overall access to effective programs. The purpose of this investigation was to assess the feasibility, acceptability, and preliminary efficacy of a novel telehealth exercise program designed specifically for rural cancer survivors with CRF. Methods: A single-arm clinical trial of the BfitBwell Telehealth Program was performed. This program employed synchronous exercise sessions using videoconference software (2/program), asynchronous exercise sessions using a personal training smartphone/internet application (3-5/week), and regular symptom (CRF) monitoring using automated emailed surveys (every two weeks). Personalized exercise programs containing aerobic and resistance activities were created and supervised by Cancer Exercise Specialists. Symptom-triggered synchronous exercise sessions were initiated for participants failing to improve in CRF, as identified by a reference chart of CRF improvements seen during a supervised exercise program. Eligible participants were adult survivors of any cancer diagnosis who had completed treatment with curative intent in the past 12 months or had no planned changes in treatment for the duration of the study, lived in a rural area, and were currently experiencing CRF. Feasibility was assessed by recruitment and acceptability (attendance and survey completion). CRF and secondary outcomes of other patient-reported outcomes and objective physical function were assessed before and after the program and at a six-month follow-up. Results: 19 participants enrolled in the study, 16 initiated the exercise program, and 15 completed the program. The majority of enrolled participants (74%) were recruited through internet and social media advertisements and recruitment rate peaked at five enrolled participants/month. Participants completed an average of 94% of emailed surveys, attended 97% of synchronous exercise sessions, and completed 85% of asynchronous exercise sessions. Six participants required symptom-triggered sessions with an 80% average attendance. CRF significantly improved (P=.001) following the program and 13 participants demonstrated at least a minimal clinically important difference in CRF at this time. CRF did not significantly change in the six months following the program. Conclusions: This investigation demonstrated the feasibility, acceptability, and preliminary efficacy of a telehealth exercise program designed specifically for rural cancer survivors with CRF. The program provides a potential model for improving exercise program efficacy and efficiency through asynchronous exercise prescription.