Searching for maintenance in exercise interventions for cancer survivors

Abstract

Purpose Translating evidence-based exercise interventions into practice is important for expanding the capacity to support cancer survivors. Using the reach, efficacy/effectiveness, adoption, implementation, and maintenance (RE-AIM) framework and scoping study methodology, we addressed the research question, “What is known about the maintenance of exercise interventions for cancer survivors that would inform translation from research to practice and community settings?” Maintenance was investigated at the individual and setting level. Methods Literature searches were performed in the PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Sport Discus databases for articles published from January 2009 to June 2012. Abstracts were judged using a priori criteria for the survivor population, exercise intervention, and maintenance on the individual or setting level. We included completed and planned randomized controlled trials (RCTs) and other study designs. Publications meeting the criteria were reviewed and coded. Results Of the 211 abstracts meeting patient and exercise criteria, 24 (19 RCTs) met the maintenance criteria. Nine of the 12 completed RCTs demonstrated maintenance of intervention outcomes after 3 to 14 months of follow-up. The planned RCTs described interventions lasting 2 to 4.5 months and maintenance intervals lasting 3 to 12 months following the active intervention. Maintenance at the setting level was reported in one publication. Conclusions On the individual level, intervention outcomes were maintained in most studies, in a variety of settings and survivor subpopulations. Maintenance on the setting level was scarcely addressed. This scoping study suggests several strategies that could be taken by agencies, clinicians, and researchers to develop more effective and sustainable exercise programs for cancer survivors. Implications for Cancer Survivors Many benefits of exercise training are maintained for months after cancer survivors complete controlled research studies but relatively little is known about how to translate research to sustainable community-based exercise programs. A better understanding of how programs can be sustained in practice beyond short-term research or grant funding is needed to support a growing number of survivors.

Efficacy of a Mobile-Enabled Web App (iCanFit) in Promoting Physical Activity Among Older Cancer Survivors: A Pilot Study

“…Thus, effective interventions must be multi-faceted and recognize that older adults are likely to have co-morbidities which bring greater complexity to adopting and maintaining healthy lifestyles [23,24]. In this study, all older cancer survivors had multiple chronic conditions, which is important to consider when determining their specific needs and barriers to physical activity [25,26]. For example, more tailored messages about how to manage chronic conditions and tips on easy access to opportunities for physical activity and enhanced communication with healthcare providers may be helpful [27-29].…”

Exercise is medicine in oncology: Engaging clinicians to help patients move through cancer

“…For HCP‐supervised exercise programs, third‐party payers may offer partial coverage, yet gaps between insurance coverage and program costs may be insurmountable for many patients without institutional support. Funding for community‐based programs is often vulnerable and short‐term . Some LIVESTRONG at the YMCA and UK‐based MoveMore projects transition into fee‐based models after set intervals.…”

“…Funding for community-based programs is often vulnerable and shortterm. 84 Some LIVESTRONG at the YMCA and UKbased MoveMore projects transition into fee-based models after set intervals. These user-pay models potentially provide a sustainable option provided there is committed baseline financial support from a community partner.…”

Self-reported physical activity behavior of breast cancer survivors during and after adjuvant therapy: 12 months follow-up of two randomized exercise intervention trials

“…Exercise interventions in the context of clinical trials typically increase (or prevent therapy-related decline of) the activity level of most participants in the course of the intervention. However, while physical activity behavior of cancer patients in general has been studied for over a decade [5], data on the maintenance of physical activity in the long term beyond the duration of an intervention is still scarce and inconclusive [6,7]. While some studies reported a sustained effect [8,9], others observed insufficient activity levels or declined levels several months post-intervention [10,11].…”