Exercise interventions for people diagnosed with cancer: a systematic review of implementation outcomes

Abstract

Purpose Exercise is efficacious for people living after a cancer diagnosis. However, implementation of exercise interventions in real-world settings is challenging. Implementation outcomes are defined as ‘the effects of deliberate and purposive actions to implement new treatments, practices, and services’. Measuring implementation outcomes is a practical way of evaluating implementation success. This systematic review explores the implementation outcomes of exercise interventions evaluated under real-world conditions for cancer care. Methods Using PRISMA guidelines, an electronic database search of Medline, PsycInfo, CINAHL, Web of Science, SportsDiscus, Scopus and Cochrane Central Registry of Controlled Trials was conducted for studies published between January 2000 and February 2020. The Moving through Cancer registry was hand searched. The Implementation Outcomes Framework guided data extraction. Inclusion criteria were adult populations with a cancer diagnosis. Efficacy studies were excluded. Results Thirty-seven articles that described 31 unique programs met the inclusion criteria. Implementation outcomes commonly evaluated were feasibility (unique programs n = 17, 54.8%) and adoption (unique programs n = 14, 45.2%). Interventions were typically delivered in the community (unique programs n = 17, 58.6%), in groups (unique programs n = 14, 48.3%) and supervised by a qualified health professional (unique programs n = 14, 48.3%). Implementation outcomes infrequently evaluated were penetration (unique programs n = 1, 3.2%) and sustainability (unique programs n = 1, 3.2%). Conclusions Exercise studies need to measure and evaluate implementation outcomes under real-world conditions. Robust measurement and reporting of implementation outcomes can help to identify what strategies are essential for successful implementation of exercise interventions. Implications for cancer survivors Understanding how exercise interventions can be successful implemented is important so that people living after a cancer diagnosis can derive the benefits of exercise.

Train at home, but not alone: a randomised controlled multicentre trial assessing the effects of live-streamed tele-exercise during COVID-19-related lockdowns

“…38 Dropout is a general problem in many longitudinal trials involving exercise interventions. Pooling data from 37 studies in patients with cancer, Czosnek et al 47 reported a mean attrition rate of 38% with a range of 22%-56%. Joseph et al 48 systematically reviewed internet-based PA interventions, reporting a mean attrition rate of 22.3% with a range between 0% and 69%.…”

Determinants for Exercise Adherence and Maintenance for Cancer Survivors: Implementation of a Community-based Exercise Program. A Quality Feasibility Study

“…Generally, cancer survivors report maintenance of exercise after treatment as challenging, and there is a need for implementation of exercise program in community setting for this population (16,26). The design of an exercise program can be essential for a successful implementation of exercise among cancer survivors.…”

“…Community-based exercise groups for cancer survivors of mixed diagnoses and ages are safe, show physiologic and psychosocial bene ts and it is a valid setting to improve survivor care and promote adherence to PE (23)(24)(25). However, implementation of exercise interventions in real-world setting is challenging (26). There is a need for qualitative research to understand the contextual dimensions of group-based exercise for cancer survivors, which may be of importance in the application, implementation and dissemination of community-based exercise programs in clinical practice.…”

A Scoping Review Examining the Integration of Exercise Services in Clinical Oncology Settings

“…EE and DN developed the search strategy using a well-de ned systematic approach. (34) Relevant search terms and medical subject headings (MeSH) were identi ed by exploring the National Library of Medicine Database and, further, by reviewing a recent review of exercise intervention for cancer survivors (35). Speci c keywords and MeSH terms applied in the search include (but are not limited to) cancer, exercise, feasibility, etc., and implementation outcomes such as acceptability, adoption, appropriateness, practicality (See Additional File 1).…”