ABSTRACT
Aims: Assess the implementation of a telehealth supervised group exercise (tele-exercise) program for patients with cancer, using the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance). Method(s): Cancer patients with medical clearance and access to home internet participated in a physiotherapy-led tele-exercise program, comprising twice-weekly sessions for 12 weeks and featuring aerobic, resistance and balance exercises. A Garmin activity tracker was worn during sessions. Subjective (fatigue, quality of life) and objective (muscle strength, cardiorespiratory fitness, balance) measures were taken pre and post-program. Qualitative interviews (analysed using thematic and content analyses) and an online survey were completed post-program. Result(s): Reach: Twenty-six eligible participants consented and were enrolled. Twenty-four commenced the program, most of whom were female (92%), diagnosed with breast cancer (75%), treated with surgery (96%), chemotherapy (88%) or radiation therapy (54%). Effectiveness: FACIT-F scores indicated reduced fatigue (mean difference 5.8 [95% CI 1.9-9.8], p < 0.01). Improvements were seen across several strength, fitness and balance outcomes (e.g. upper body strength +5.6 [2.6-8.6] kg, p < 0.01). There were no changes to quality of life (FACT-G). Adoption: Participants found classes easy to integrate into daily routines and felt it helped avoid negative aspects of in-person exercise (e.g. COVID-19 exposure, parking). Recruitment improved after introducing a 6:30 am class. Most (78%) participants felt very confident using the technology. Viewing heart rate via the Garmin device contributed to feeling safe whilst exercising. Implementation: 21 of 24 participants completed the program. Mean number of sessions attended was 22. Maintenance: Participants suggested feasible improvements to program orientation, discharge, and the exercise classes. All felt comfortable using the internet for tele-exercise. The majority considered a telehealth class as equal to an in-person class (15 of 18, 83%). Conclusion(s): A telehealth group exercise program for people with cancer was successfully implemented. Further information is needed regarding non-breast cancer patients and non-tertiary hospital settings.