This review aims to summarize the recommendations endorsed by scientific societies regarding physical activity for patients with cancer. A systematic search was conducted to identify guidelines endorsed by scientific societies and published in the last 15 years dedicated to physical activity for cancer patients. The AGREE II instrument was used to assess the methodological quality of the guidelines. Results are presented as qualitative synthesis. A total of 11 guidelines met the inclusion criteria. Seven were considered high quality, scoring ≥60 % in the AGREE II tool. All the guidelines recommended to include aerobic and resistance training as types of activities. Regarding the physical activity dosage, most suggested a generic 150 minutes/week of moderate-intensity activity plus resistance training twice a week. Three guidelines reported instructions for exercise prescription, including frequency, intensity, and duration of training sessions. Six guidelines reported exercise testing/medical clearance instructions, 9 provided considerations regarding adaptation/precautions, and 7 detailed the specialists for referral. Four guidelines considered motivational aspects related to physical activity and cancer. Although important steps have been made in the more recent recommendations, effort is needed to produce high-quality research in the exercise-oncology field, with the ultimate aim of developing more tailored guidelines.

Exercise is recommended during anti-cancer treatments. However, there is lack of knowledge about existing barriers to participation in exercise-based trials, especially among understudied groups such as older patients and those with advanced cancer.

To explore reasons for refusal of participation in an exercise-based study among older patients with advanced cancer and identify factors associated with higher likelihood of declining.

A mixed methods design was applied, using qualitative data from interviews and quantitative data from medical records. We investigated potential differences in characteristics between patients who accepted and declined. Qualitative data underwent thematic analysis, and findings were synthesized to generate meta-inferences.

Among 34 invited patients, 20 (59%) agreed to participate in the interviews, and 261 of 269 (97%) patients were included in quantitative analyses. Meta-inferences identified factors related to refusing exercise participation, including older age, perceptions of being sufficiently active, physical limitations, and awareness of having a poor prognosis.

Refusal of participation was particularly related to advanced cancer, physical limitations, and older age. To address these barriers, it is recommended to adopt a holistic and supportive approach and improve the flexibility of recruitment strategies.

Exercise during neoadjuvant chemoradiotherapy (NCRT) has potential to mitigate treatment-related declines in physical fitness, and to improve clinical outcomes, including toxicity and tumor response. However, optimal frequency and timing of exercise remains to be determined. Therefore, this pilot trial aimed to assess feasibility of 2 different exercise interventions during NCRT in patients with esophageal and rectal cancer and to evaluate potential clinical effects.

Patients were randomized into 1 of 3 study arms during NCRT: (a) 30-min aerobic exercise in-hospital within 1 h prior to each radiotherapy fraction (ExPR), (b) two 60-min supervised combined aerobic and resistance exercise sessions per week (AE+RE), and (c) usual care (UC). Feasibility was assessed by examining participation rate and exercise adherence. Intervention effects on physical fitness, health-related quality of life, treatment-related toxicity, and tumor response in patients with esophageal cancer were explored using regression analyses and 85% confidence intervals (85%CI).

Thirty-seven patients with esophageal cancer (participation rate: 45%) and 2 patients with rectal cancer (participation rate: 14%) were included. Median session attendance was 98% (interquartile range (IQR): 96-100) in the ExPR and 78% (IQR: 33-100) in the AE+RE group. We found clinically relevant benefits of exercise on maximal oxygen uptake (VO2max)(ExPR: β = 9.7 mL/kg/min, 85%CI: 6.9-12.6; AE+RE: β = 5.6 mL/kg/min, 85%CI: 2.6-8.5) and treatment-related toxicity (ExPR: β = -2.8, 85%CI: -5.4 to -0.2; AE+RE: β = -2.6, 85%CI: -5.3 to 0.0). Additionally, good tumor response was found in 70% in AE+RE and ExPR vs. 55% in UC (OR = 1.9, 85%CI: 0.5-7.7).

Starting prehabilitation during NCRT is feasible, can increase starting fitness of traditional pre-surgical programs, and has potential to improve clinical outcomes.

The incidence of cancer in older patients is high, reaching 2.3 million world-wide in 2018 for patients aged over 80. Because the characteristics of this population make therapeutic choices difficult, co-management between geriatricians and other cancer specialists has gradually become essential.

This narrative review aims to synthesize current data on the contribution of geriatric assessment in the management of elderly patients with non-colorectal digestive cancers. Oncogeriatric assessment is multi-domain, including the evaluation of co-morbidities, autonomy, nutrition, cognition, mood, and functional assessment.

Oncogeriatric parameters are predictive of mortality and adverse events. In the peri-operative phase of non-colorectal digestive cancer surgical management, geriatric management can assist in the decision-making process, identify frailties, and arrange a specific and personalized trimodal preoperative rehabilitation program, including nutritional management, adapted physical activity, and psychological care. Its aim is to limit the risks of confusion and of decompensation of comorbidities, mainly cardio-respiratory, which is associated with the highest morbidity in biliary-pancreatic surgery for older adults, facilitate recovery of previous autonomy when possible, and shorten hospital stay. For metastatic cancers, or during multimodal management, such as peri-operative chemotherapy for localized gastric cancers or pre-operative radio-chemotherapy for oesophageal or rectal cancers, specific assessment of the tolerance of chemotherapy is necessary. Neuropathic toxicity and chemobrain have a greater impact on elderly patients, with an increased loss of autonomy. Joint geriatric management can reduce the rate of grade 3-5 adverse effects of chemotherapy in particular and improve quality of life.

Co-management between geriatricians and other specialties should be encouraged wherever possible.

Physical activity (PA) declines with age, with chronic health conditions a contributing factor. Exercise motivation (EM), a factor of PA adherence, may be promoted through community program participation. The purpose was to investigate the effect of health conditions and community program participation on PA and EM. Surveys comprising of demographics, physical activity (PASE), and exercise motivation (BREQ-2), were distributed. Significant differences were found for PA between community program participants with and without a health condition. A significant main effect for health condition existed on several subscales of EM: identified regulation and intrinsic regulation, and for obesity on amotivation, identified regulation, and intrinsic regulation. Significant differences existed between community exercise program participants (N = 77) and non-participants (N = 145) for amotivation (p < 0.001), identified regulation (p < 0.001), and intrinsic regulation (p < 0.001). The presence of a health condition appears to impact EM. Community program participation positively influenced EM, potentially negating the effect of health condition.

The feasibility, safety, acceptability, and perceptions of exercise in older adults with advanced disease are not well understood due to the scarcity of evidence. This scoping review aimed to (1) summarize evidence on the feasibility, acceptability, and safety of exercise interventions for older adults with advanced cancer and (2) explore this population's perceptions on participating in exercise programs.

A systematic search was conducted by an expert research librarian in Medline, CINAHL, EMBASE, Cochrane CENTRAL, and SPORTDiscus (inception through November 2023). Eligible studies included older adults with advanced (stage IV or receiving treatment with non-curative intent) solid cancers and intervention or qualitative studies on physical activity/exercise in older adults pertaining to our objectives.

A total of 36 studies were included: 28 (78 %) intervention studies, seven (19 %) qualitative studies, and one (3 %) cross-sectional study. The Frequency/Intensity/Time/Type (FITT) principle was described in 18 studies (64 %). Feasibility was examined in 15 of the 28 intervention studies (54 %) using various definitions. Four studies had predetermined feasibility thresholds, yielding mixed results. One intervention study reported on two intervention-related severe adverse events. Nineteen of the 28 intervention studies (68 %) examined acceptability, reporting high levels of participant satisfaction. Qualitative data revealed several barriers and facilitators to exercise.

Exercise appears to be feasible, acceptable, and safe in older adults with advanced cancer. Consistent reporting on the FITT principle and feasibility operationalization are areas of improvement in exercise studies in older adults with advanced disease.

This study aimed to compare the effects of isocaloric polarized and threshold training intensity distribution on endurance capacity in breast and prostate cancer survivors. A total of 28 breast and 27 prostate cancer survivors were randomly assigned to a polarized (POL, n = 27 (13 women), age 60 ± 8 years, peak oxygen uptake (VO2peak) 23 mL·min-1 kg-1), or threshold training group (ThT, n = 28 (15 women), age 59 ± 10 years, VO2peak 23 mL·min-1 kg-1) who completed two sessions per week on a cycle ergometer over 12 weeks. Exercise duration was adapted to obtain equivalent energy expenditure in both groups. Cardiopulmonary exercise and verification tests were performed to determine endurance capacity (VO2peak, peak power output (PPO), ventilatory threshold (VT1), blood lactate thresholds (LT1 and IAT)), and maximal exhaustion. POL did not achieve the planned polarized intensity distribution and rather performed a pyramidal training. Pyramidal and threshold training significantly (p < 0.001) improved endurance capacity regarding VO2peak (0.09 and 0.12 L·min-1), PPO (27 and 17W), power output at VT1 (11 and 13W), oxygen uptake at VT1 (0.09 and 0.11 L·min-1), power output at LT1 (7 and 12W), and power output at IAT (12 and 14W). No difference was found between groups, but ThT required significantly (p < 0.001) less time than pyramidal training to achieve the described improvements (59 ± 1 min/week vs. 76 ± 11 min/week). Comparison of isocaloric training intensity distributions revealed no significant differences between groups (Pyramidal: 170 ± 43 kJ/session, ThT: 175 ± 35 kJ/session, p = 0.10). Pyramidal and isocaloric threshold training resulted in comparable effects on endurance capacity in cancer survivors, with ThT requiring significantly less time for these effects.

As the number of cancer patients and survivors increases, we face a rising challenge: the long-term impact of the adverse effects of cancer treatment. One of the known adverse effects is chemotherapy-induced peripheral neuropathy (CIPN), which courses with pain complaints. The treatments of CIPN have reduced efficacy. The neurobiological causes of CIPN have been mainly ascribed to peripheral nerve damage, but recent studies show effects in the brain, namely in the descending pain modulatory systems. Physical exercise seems to be associated with better outcomes in CIPN patients, but the mechanisms underlying the effects have not been discussed, namely considering the recent results of the effects of CIPN in brain structures involved in pain modulation. In this critical review, we propose that the beneficial effects of exercise in CIPN also have central mechanisms, namely neuroinflammation and oxidative stress, as well as changes in the actions of neurotransmitters and neurotrophic factors, with a direct effect on optimizing the endogenous pain modulation, namely opioids, monoamines, and endocannabinoids. The effects are multifactorial, as mood improvement and the other psychological benefits of exercise should be considered. The emerging role of the microbiome, which is affected during CIPN, also needs to be considered. This review critically synthesizes the available literature to highlight how the neurobiological effects of physical exercise make it a promising strategy for managing CIPN, both from preventive and treatment perspectives.

To examine the comprehensive health impacts of exercise on people with cancer by systematically summarising existing evidence and assessing the strength and reliability of the associations.

Umbrella review of meta-analyses.

PubMed, Embase, Cochrane and Web of Science databases were searched from their inception to 23 July 2024.

Meta-analyses of randomised controlled trials that investigated the associations between exercise and health outcomes among people with cancer.

This umbrella review identified 485 associations from 80 articles, all evaluated as moderate to high quality using A Measurement Tool to Assess Systematic Reviews (AMSTAR). Two hundred and sixty (53.6%) associations were statistically significant (p<0.05), 81/485 (16.7%) were supported by high-certainty evidence according to the Grading of Recommendations Assessment, Development, and Evaluation criteria. Compared with usual care or no exercise, moderate- to high-certainty evidence supported the view that exercise significantly mitigates adverse events associated with cancer and its treatments (eg, cardiac toxicity, chemotherapy-induced peripheral neuropathy, cognitive impairment and dyspnoea). Exercise also modulates body composition and biomarkers (eg, insulin, insulin-like growth factor-1, insulin-like growth factor-binding protein-1 and C-reactive protein) in people with cancer, and enhances sleep quality, psychological well-being, physiological functioning and social interaction, while improving overall quality of life.

Exercise reduces adverse events and enhances well-being through a range of health outcomes in people with cancer.

Although quality-assured oncological exercise therapy (qOET) has proven effective for cancer patients at any stage of treatment and during aftercare, it is not yet incorporated into standard care in Germany and, to the best of our knowledge, in any other country. A collaboration involving eight German research institutions was initiated to investigate the barriers and facilitators to implementation and promote the wider dissemination of qOET for cancer patients across various settings in Germany.

The IMPLEMENT project is designed as an exploratory study with a quasi-experimental design and a mixed-methods approach, combining qualitative and quantitative data collection. Institutions involved in the treatment and/or aftercare of cancer patients will be approached to identify key barriers and facilitators of qOET. Based on these findings, a set of implementation strategies (IPS) will be developed, implemented, and evaluated to facilitate the delivery of qOET for cancer patients. We aim to develop a variety of IPS for different contexts: urban settings (e.g. qualifying local aftercare institutions to provide qOET); rural settings (e.g. a hybrid approach for areas with limited access to local qOET services); adult cancer patients (e.g. focussing on patient education); and children and young cancer patients (e.g. offering consultations with training therapy experts). Additionally, interface management, training concepts, digital support, and economic evaluation will be considered to further promote the wider dissemination of qOET. The impact of the IPS will primarily be measured by the reach of qOET, assessed by comparing the number of cancer patients receiving qOET before and after implementation.

The aim of IMPLEMENT is to address key barriers and facilitators for the implementation of qOET in Germany, and to increase the number of cancer patients receiving qOET in the long term. Following the project, successful IPS will be disseminated for broader application. The IMPLEMENT consortium aims to make a significant contribution to the long-term integration of qOET into the standard care of cancer patients in Germany and prospectively for other countries as well.

Clin.

NCT06496711. German Clinical Trial Register (Deutsches Register Klinischer Studien - DRKS): 00032292. Bavarian Cancer Research Center (Bayerisches Krebsforschungszentrum (BZKF bzw. ZKS): DZ-2024-2165-9.

To understand the effect of prehabilitation interventions on ≥30 days post-treatment outcomes including physical functioning, clinical, and patient-reported outcomes in people affected by bladder cancer.

This systematic review included all randomized, quasi-randomized, or single-arm studies in patients affected by bladder cancer (irrespective of stage or treatment modality) that compared prehabilitation intervention(s) with standard care. A range of key terms related to bladder cancer and prehabilitation were developed to search the four electronic databases. Articles were assessed according to predetermined inclusion and exclusion criteria. A methodological quality assessment was performed.

Of the 932 studies identified, 14 studies were included and represented 1,034 participants. The interventions included multimodality prehabilitation (n = 5), exercise-only programs (n = 3), nutrition-focused interventions (n = 2), educational support (n = 3), and smoking/alcohol cessation counseling (n = 1). All of the studies were conducted in patients treated by surgery, therefore clinical and research gaps exist in the prehabilitation interventions among patients treated by intravesical therapy (ie, BCG) or radiotherapy. The key findings highlighted that multimodal program mainly showed improvements in physical function outcomes. Exercise-only interventions demonstrated some benefits in physical function. Nutrition-only interventions did not show any statistically significant improvements. Education programs showed improvements in patient-reported outcomes. Smoking and alcohol cessation counseling achieved notable abstinence rates, which were associated with fewer postoperative complications.

This review suggests that prehabilitation interventions may benefit patients with bladder cancer, particularly exercise and education programs, which showed improvements in physical function and patient-reported outcomes. However, the evidence remains inconclusive, with no clear impact on clinical outcomes such as complications or hospital stay. More robust studies are needed to determine the most effective prehabilitation strategies for patients with bladder cancer.

Glioblastoma (GB) is the most common primary malignant brain tumour in adults. Physical activity (PA) has value as a supportive service for individuals living with a GB diagnosis to help maintain quality of life and physical functioning. The objective of this study is to understand how oncology care providers (OCPs), family/friend caregivers, and health system decision makers can include conversations of PA into care for those living with a GB. We conducted 19 semi-structured interviews guided by the Capability, Opportunity, Motivation-Behaviour (COM-B) model and further refined them by the theoretical domains framework (TDF). The data were then analyzed using a directed content analysis using a codebook generated using the TDF. Patients and family/friend caregivers appreciated hearing about PA from their OCPs, from initial diagnosis into follow-up appointments, and they saw PA as a way to take a break from cancer/medically focused care, and historical PA behaviours did not mean patients were more or less likely to be open about PA discussions. This study further emphasises the inclusion of PA discussions in clinical care. OCPs in GB care feel they have the knowledge to partake in PA conversations, and GB patients are open to having these conversations. However, specific barriers are in place that do not lead to widespread implementation of PA discussions for all patients.

The prevalence of cancer in Canada is growing, leading to multiple lasting side effects in survivors. The physical and psychosocial benefits of regular physical activity (PA) during and after treatment for individuals with cancer are well established, however, not well implemented in a clinical setting. The overall aim of this project is to build on previous work and conduct a multicentred randomised controlled trial (RCT) and evaluate the effectiveness of a novel implementation strategy using PA and self-management versus usual care during cancer treatment.

Study design: a hybrid implementation-effectiveness RCT will occur at five cancer centres across Ontario, Canada. Participants: eligible participants include adults with a cancer diagnosis (any type or stage) who are receiving treatment and cleared for exercise by their oncology care team. Intervention: participants (n=129) will be randomised to one of three groups: (1) institution-based exercise and self-management (SM) (eight in-person sessions of aerobic exercise and eight SM modules), (2) SM alone (SM only: eight virtual modules) or (3) usual care (no intervention). Outcomes: the Reach, Effectiveness, Adoption, Implementation and Maintenance framework will assess implementation outcomes. The primary effectiveness outcome is self-report PA level postintervention. Data analysis: outcomes will be measured at four time points (baseline, postintervention, 6- and 12-month follow-up). Descriptive statistics will be used to present implementation outcomes. An analysis of covariance will assess change between groups over time.

Findings from this trial will build on previous work and inform the way PA services are provided within cancer institutions across Ontario, Canada, and inform decision-making on how to incorporate exercise evidence into real-world clinical practice in cancer care. The Hamilton Integrated Research Ethics Board (ID: 7673 & 17454) has approved this study. Results will be disseminated using a combination of peer-reviewed publications, conference presentations and community organisation presentations. Participants will contribute to dissemination by sharing 'participant perspectives', highlighting their experience in the project and thoughts on the implementation strategies used.

The study is registered on clinicaltrials.gov (ID: NCT06323707).

Haematological cancer affects more than 1.3 million people around the world annually and accounted for almost 800,000 deaths globally in 2020. The number of patients with these cancers undergoing bone marrow transplant is increasing. Of note, this intensive treatment is associated with complex and multifactorial side effects, often impacting nutritional status, physical functioning and overall health-related quality of life. The primary aim of this study is to investigate the effectiveness of an eight-week multidisciplinary rehabilitation intervention compared with usual care on the physical function domain of the European Organisation for the Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ-C30 version 3) in patients with haematological cancer following bone marrow transplant.

This is a multisite, pragmatic two-arm parallel-group, randomised controlled trial (RCT) with stratified randomisation, powered for superiority, recruiting 170 participants at 30 days following either allogeneic or autologous bone marrow transplant (ACTRN12622001071718). Recruitment sites include three Australian university affiliated teaching hospitals. Participants are eligible if aged ≥ 18 years, treated for haematological cancer with allogeneic or autologous bone marrow transplant and can walk independently. The intervention group will receive eight weeks of twice weekly telehealth-based exercise classes, an initial and follow up dietetics consult, post exercise protein supplements, and a home-based physical activity program, all with embedded behaviour change strategies. The primary outcome is patient reported physical function measured using the EORTC QLQ-C30 version 3. Secondary outcomes include other domains of the EORTC QLQ-C30, fatigue, physical function, physical activity levels, frailty, body composition, sarcopenia and nutrition assessment. We will also undertake a health economic analysis alongside the trial and a process evaluation exploring intervention fidelity, causal mechanisms as well as contextual influences through qualitative enquiry.

The REBOOT trial will add RCT-evidence from a rigorously conducted, statistically powered multi-site trial to existing limited knowledge on the effects of multi-disciplinary rehabilitation for people with haematological cancer. If effectiveness is supported, then implementation of rehabilitation into care pathways for people having bone marrow transplant can be considered.

ACTRN12622001071718 prospectively registered 03/08/2022, last updated 08/03/2024.

Background/Objectives: This study aims to evaluate the health-related quality of life (HRQoL) of children and adolescent cancer survivors in relation to previously published normative values for typically developing children and adolescents, as well as to analyze the differences in HRQoL based on their levels of physical activity and fitness. Methods: Cross-sectional study with 116 cancer survivors (12.1 ± 3.3 years, 57.8% boys) from two pediatric oncology units in Andalusia (Spain). HRQoL was assessed using PedsQL 4.0 Generic Core Scales. Physical activity was measured with accelerometers, and fitness was evaluated using self-reported and objective tests for muscular fitness. Independent samples t-tests to compare HRQoL between our sample and the normative values published for typically developing children and adolescents of the same age and analysis of covariance (ANCOVA) were conducted to assess differences in HRQoL according to physical activity and fitness categories in our sample. Results: Children and adolescent cancer survivors had lower HRQoL scores compared to typically developing children's and adolescents' normative values, except for social functioning. Higher levels of moderate-to-vigorous physical activity were associated with better total, physical, and psychosocial HRQoL scores. Children and adolescent cancer survivors with better levels of cardiorespiratory fitness, motor fitness, and flexibility reported better HRQoL scores in total and psychosocial domains. However, muscular fitness (self-reported and objectively measured) did not show a significant difference in HRQoL. Conclusions: Children and adolescent cancer survivors experience lower HRQoL than their typically developing counterparts. Engaging in at least 30 min of moderate-to-vigorous physical activity per day is associated with fewer HRQoL impairments. Improved fitness, particularly cardiorespiratory fitness, motor fitness, and flexibility, are associated with better HRQoL outcomes. These findings highlight the association between physical activity, fitness levels, and HRQoL in children and adolescent cancer survivors, suggesting the potential benefits of promoting physical activity and enhancing fitness levels.

Background Physical fitness (PF) is a critical determinant of health, influencing cardiorespiratory endurance, muscular strength, and overall metabolic function. In Qatar, sedentary lifestyles and physical inactivity are prevalent, contributing to increasing rates of obesity and non-communicable diseases. Structured physical exercise programs, integrated into community wellness centers, offer a practical intervention to improve PF, yet their real-world effectiveness remains under-evaluated in the local context. Methods This retrospective study analyzed data from 739 adults who completed a 12-week structured physical exercise program at seven wellness centers operated by Primary Health Care Corporation (PHCC), Qatar, between January 2022 and December 2023. The program consisted of three weekly supervised sessions combining aerobic and resistance exercises, with heart rate monitored to maintain moderate intensity (≥70% of maximum heart rate). Pre- and post-program assessments measured VO2 max (using the Cooper 12-minute test), muscular endurance (push-ups, wall sit, plank), and anthropometric data of weight, body mass index (BMI), waist circumference (WC), and fat mass. Paired t-tests assessed changes in the means before and after the physical exercise program, and correlation analysis explored relationships between fitness improvements and demographic or anthropometric factors. Results After 12 weeks, VO2 max increased significantly (mean difference = 2.47 mL/kg/min; p < 0.001), alongside improvements in muscular endurance (push-ups: +4 reps; wall sit: +18 seconds; plank: +16.77 seconds; all p < 0.001). Significant reductions were observed in weight (-0.95 kg), BMI (-0.27 kg/m²), WC (men: -0.99 cm; women: -2.34 cm), and fat mass (-1.42 kg) (p < 0.001). Correlation analysis revealed a weak negative correlation between age and VO2 max change (r = 0.061), indicating that younger participants tended to show more remarkable aerobic improvement. Higher BMI and fat mass also correlated negatively with VO2 max gains (r = -0.094 and r = -0.083, respectively). At the same time, gender showed minimal correlation with fitness changes, suggesting that baseline body composition and age influence exercise response more than sex. Conclusion The structured 12-week exercise program significantly improved PF among adults in community wellness settings. These findings support integrating exercise prescriptions into primary care, to enhance population-level fitness and prevent chronic disease in Qatar.

Evidence on the efficacy of psychological interventions targeting cancer patients diagnosed with an adjustment disorder is scarce.

This study aimed to investigate the efficacy and budget impact of a tailored psychological intervention program (AD-program) targeting cancer patients with adjustment disorder (AD).

Patients (n = 59) were randomised to the intervention or control group. The AD-program consisted of three modules: psychoeducation (1-4 sessions) and two additional modules (maximum of 6 sessions per module) provided when needed. The primary outcome was psychological distress (HADS). Secondary outcomes were mental adjustment to cancer (MAC) and health-related quality of life (EORTC QLQ-C30). Measures were completed at baseline and 3 and 6 months after randomisation. The budget impact analyses were based on the population size, the costs of the AD-program, and other costs potentially affected by the AD-program.

The mean psychological distress score in the intervention group (n = 33) decreased over time (M = 19.2 at T0, M = 15.6 at T6). This decrease was not significantly different from decrease in the control condition (n = 26, M = 17.5 at T0, M = 15.9 at T6, p > 0.05). Also, there were no significant differences between the two conditions on the secondary outcomes. The budget impact of the AD-program was estimated at 7-28 million euros per year (to treat 14,430 patients).

The effect of the AD-program was not statistically significant in this RCT. Limitations include that this study was underpowered due to recruitment difficulties during the COVID-19 pandemic. More research on the efficacy and implementation of the AD-program is warranted.

Netherlands Trial Register identifier: NL7763. Registered on 3 June 2019.

Lung cancer ranks as the leading cause of cancer-related deaths. For lung cancer survivors, cardiopulmonary fitness is a strong independent predictor of survival, while surgical interventions impact both cardiovascular and pulmonary function. Home-based cardiac telerehabilitation through wearable devices and mobile apps is a substitution for traditional, center-based rehabilitation with equal efficacy and a higher completion rate. However, it has not been widely used in clinical practice.

The objective of this study was to broaden the use of digital health care in the cardiopulmonary rehabilitation of lung cancer survivors and to assess its impact on cardiopulmonary fitness and quality of life (QOL).

Early-stage nonsmall cell lung cancer survivors aged 18-70 years were included. All the participants received surgery 1-2 months before enrollment and did not require further antitumor therapy. Participants were randomly assigned to receive cardiac telerehabilitation or usual care for 5 months. Artificial intelligence-driven exercise prescription with a video guide and real-time heart rate (HR) monitoring was generated based on cardiopulmonary exercise testing. Aerobic exercise combining elastic band-based resistance exercises were recommended with a frequency of 3-5 d/wk and a duration of 90-150 min/wk. The effective exercise duration was recorded when patients' HR reached the target zone (HRresting + [HRmax - HRresting] × [≈40%-60%]), representing the duration under the target intensity. The prescription used a gradual progression in duration and action intensity based on the exercise data and feedback. Outcome measurements included cardiopulmonary fitness; lung function; cardiac function; tumor marker; safety; compliance; and scales assessing symptoms, psychology, sleep, fatigue, and QOL.

A total of 40 (85%) out of 47 patients finished the trial. The average prescription compliance rate of patients in the telerehabilitation group reached 101.2%, with an average exercise duration of 151.4 min/wk and an average effective exercise duration of 92.3 min/wk. The cardiac telerehabilitation was associated with higher improvement of maximal oxygen uptake peak (3.66, SD 3.23 mL/Kg/min vs 1.09, SD 3.23 mL/Kg/min; P=.02) and global health status or QOL (16.25, SD 23.02 vs 1.04, SD 13.90; P=.03) compared with usual care. Better alleviation of affective interference (-0.88, SD 1.50 vs 0.21, SD 1.22; P=.048), fatigue (-8.89, SD 15.96 vs 1.39, SD 12.09; P=.02), anxiety (-0.31, SD 0.44 vs -0.05, SD 0.29; P=.048), and daytime dysfunction (-0.55, SD 0.69 vs 0.00, SD 0.52; P=.02) was also observed in the telerehabilitation group. No exercise-related adverse events were identified during the intervention period.

The 5-month, digital therapeutics-based telerehabilitation improved cardiorespiratory fitness in lung cancer survivors with good compliance and safety. Patients receiving telerehabilitation also reported improved QOL with reduced levels of fatigue, anxiety, and daytime dysfunction.

Chinese Clinical Trial Registry ChiCTR2200064000; https://www.chictr.org.cn/showproj.html?proj=180594.

Black breast cancer survivors (BCS) are more likely to experience poor quality of life (QoL) compared to White BCS. Physical activity (PA) has been shown to improve QoL in cancer survivors. However, there is limited evidence demonstrating associations between PA and multiple QoL domains among Black BCS. This study examined the association between PA duration and intensity level (e.g., ≥ 150 min/week of moderate activity) and multiple QoL domains (e.g., physical health) among BCS in the Black Women's Health Study (BWHS).

A total of 904 BWHS participants were eligible to participate in this study. The 2019 BWHS follow questionnaire, which assessed multiple QoL domains was used to address the primary aim. Adjusted multinomial logistic regression models were fit to estimate the odds ratios and 95% confidence intervals for the associations with each exposure variable (PA) and outcome variable (QoL). Multiple imputation was used to address missing data.

The average participant age was 66, and the average body mass index was 29 kg/m2 at the time of QoL assessment. There were significant and positive associations between PA duration and intensity level and multiple domains of QoL (p < 0.05). Participants who engaged in higher durations of moderate PA (e.g., ≥ 150 minutes/week) had increased odds of optimal social functioning (aOR = 2.67; 95% CI 1.40, 5.08) and functional wellbeing (aOR = 4.10; 95% CI 1.71, 9.83) than those who engaged in lower durations of moderate PA (e.g., < 150 minutes/week). Compared to participants who engaged in lower durations of vigorous PA (e.g., < 60 minutes/week), those who engaged in higher durations of vigorous PA (e.g., ≥ 60 minutes/week) had greater odds of optimal physical health (aOR = 4.27; 95% CI 2.04, 8.90), social functioning (aOR = 4.48; 95% CI 2.27, 8.86), and financial wellbeing (aOR = 1.64; 95% CI 1.03, 2.63).

Black BCS who engage in higher durations of moderate and vigorous PA tend to have better QoL. These findings may help to build upon the importance of PA and the relevance of PA in the context of supportive care for racial and ethnic minority BCS. Future longitudinal studies are needed to establish clear temporal associations between PA and QoL in this group.

The primary aim was to determine the effect of a physical activity (PA) program with education sessions on walking capacity and fatigue in people with cancer. The secondary objective was to assess the factors that moderated the program's effect on walking capacity and fatigue among sociodemographic, physical capacity and symptom-related factors. Satisfaction with the program was also evaluated.

A retrospective, observational study of data from a 12-week program of twice-weekly group PA sessions combined with education sessions was conducted. The 6-min walk test (6MWT), the Multidimensional Fatigue Inventory (MFI-20) and program satisfaction were assessed. Paired t-tests were applied to assess changes in 6MWT and MFI-20. Multiple linear regressions were applied to determine the influence of age, gender, initial walking capacity and fatigue on the effects of the program.

Among the 264 participants (age 57.36 ± 12.43 years; 189 women; 134 with breast cancer), 125 (47%) completed the program. Walking capacity (+ 41.63 ± 91.00 m) and fatigue (-2.01 ± 3.77) were improved after the program (p < 0.001). Age and gender did not influence the program's effect; however, lower initial walking capacity and higher fatigue scores were associated with larger improvements after the program. Satisfaction with the program was high among participants who completed it.

Walking capacity and fatigue improved significantly after the PA program, but the drop-out rate was high. The program could be individualized based on an individual's initial walking capacity or fatigue score to enhance its effectiveness.

The purpose of the study was to investigate perceived determinants of physical activity (PA) maintenance following supervised exercise oncology rehabilitation and the acceptability of a remote coaching intervention during this period.

A phenomenological qualitative study with semi-structured interviews was conducted. Nineteen participants (16 women, 3 men) were recruited from the intervention (n = 12) and control group (n = 7) of a randomized controlled trial on the effectiveness of remote coaching following hospital-based, supervised exercise oncology rehabilitation. Participants in the intervention group received a 6-month remote coaching intervention after completing the exercise program, aimed at stimulating PA maintenance. The interviews were based on the Capability, Opportunity, and Motivation model of Behaviour (COM-B model) and the framework of acceptability (TFA) and were coded using template analysis.

Key themes regarding determinants of PA maintenance were self-efficacy, PA habits, accountability, physical complaints, and facilities. Remote coaching was perceived acceptable because it stimulated PA maintenance by offering a source of structure and social support and thereby increased accountability. Moreover, it improved confidence to perform PA, leading to increased levels of self-efficacy. The remote nature of the intervention was perceived as convenient by some of the participants, while others would have preferred additional physical appointments.

Cancer survivors considered remote coaching acceptable to stimulate PA maintenance following supervised rehabilitation. Interventions should focus on increasing accountability, self-efficacy, forming habits, and helping cancer survivors to overcome barriers.

The ability to maintain PA beyond supervised exercise oncology programs depends on many determinants. Remote coaching interventions have potential to target individually relevant determinants following exercise programs in cancer survivors.

This study aims to identify and summarize evidence on the effectiveness of exercise-based interventions on muscle mass, muscle strength, functional performance, aerobic capacity, health-related quality of life (HRQoL), feasibility of the interventions, in patients with malignant lymphoma undergoing chemotherapy.

A systematic search was conducted in six electronic databases and trials registers on November 15, 2023. Peer-reviewed randomized controlled trials (RCTs) comparing exercise intervention with controls/usual care in adults (≥18 years) diagnosed with Hodgkin's lymphoma and non-Hodgkin's lymphoma undergoing chemotherapy were considered for inclusion. All study authors were contacted to obtain unpublished subgroup data. Two reviewers independently screened and extracted data and assessed the quality of evidence using the revised Cochrane risk-of-bias tool for randomized trials.

Six RCTs published between 2009 and 2021, with 838 participants, were included. Due to clinical heterogeneity, a meta-analysis was not feasible, therefore the results were synthesized narratively. Exercise interventions during treatment were found to be feasible with few adverse events reported. The included studies indicate positive effects of exercise during chemotherapy on muscle mass, muscle strength, functional performance, aerobic capacity, and HRQoL compared to usual care.

Despite extensive search criteria, a limited number of heterogenous studies were eligible, which may explain the very low certainty of evidence for all outcomes. Nonetheless, exercise-based interventions conducted during treatment were feasible, safe and potentially effective. Further studies are needed to guide future exercise recommendations for these patients.

Individuals with coronary artery disease have poorer mental health, health-related quality of life (HR-QoL), and cognition compared with (age-matched) controls. Exercise training may attenuate these effects. The aim is to systematically review and meta-analyse the effects of different exercise types and settings on brain structure/function, cognition, HR-QoL, mental health (e.g. depression, anxiety), and sleep in patients with coronary artery disease.

A systematic search was conducted and a network meta-analysis compared (i) exercise types, high-intensity interval training (HIIT), HIIT + resistance (HIIT + R), moderate-intensity training (MIT), MIT + R and stretching-toning-balance training, and (ii) exercise settings, in-person and home-based.

A total of 42 randomized controlled trials with a parallel group design were identified, of which 36 were included in the meta-analysis. Few studies included cognition (n = 2), sleep (n = 2), and none brain structure/function (n = 0). Most studies examined HR-QoL (n = 30), depression (n = 15), and anxiety (n = 9), in which outcomes were meta-analysed. HIIT + R, HIIT, and MIT were associated with improved HR-QoL vs. no exercise (i.e. usual care) [standardized mean difference, SMD: 1.53 (95% confidence interval 0.83; 2.24), 0.44 (0.15; 0.73), and 0.44 (0.20; 0.67), respectively]. In-person exercise was associated with larger and significant improvements [HR-QoL SMD: 0.51 (0.28; 0.74), depressive SMD: -0.55 (-1.03; -0.07), and anxiety symptoms SMD: -1.16 (-2.05; -0.26)] compared with no exercise, whereas home-based programmes were not significantly associated with improvements in these outcomes. Findings were robust in secondary (i.e. intervention duration and volume) and sensitivity analyses excluding high risk of bias studies.

Exercise training, especially in-person sessions, was associated with improved HR-QoL, depression and anxiety, independently of exercise type. However, this study raises concern about the effectiveness of home-based programmes in improving these outcomes.Study protocol was registered in PROSPERO (ID: CRD42023402569).

Prostate cancer is highly prevalent in Spanish men. Although physical activity has benefits on several factors in prostate cancer survivors, this is diminished after medical oncology treatment. Cancer-related fatigue is one of the main barriers to physical activity, leading to a decrease in activity levels in these patients. Therefore, it is essential to assess physical activity in an efficient and simple way in order to design rehabilitation programmes for this population.

The aim was to translate and adapt the Godin-Shephard Leisure-Time Physical Activity Questionnaire (GSLTPAQ) for Spanish-speaking prostate cancer patients and to assess its validity and reliability using the International Physical Activity Questionnaire (IPAQ) as a reference standard.

Following Beaton's guidelines, the GSLTPAQ was back-translated and cross-culturally adapted. Validity and reliability were assessed with a sample of thirty prostate cancer patients. Internal consistency and test-retest variability were also evaluated.

The Spanish GSLTPAQ demonstrated excellent validity, with high correlations with the IPAQ for light (r = 0.924), moderate (r = 0.931), and vigorous activities (r = 0.882). Internal consistency was strong (Cronbach's alpha: 0.845-0.950). Test-retest reliability showed strong intraclass correlation coefficients (ICCs) for all activity levels, indicating good reliability.

The Spanish version of the GSLTPAQ is a valid and reliable tool for assessing physical activity in prostate cancer patients. It shows strong correlations with the IPAQ, excellent internal consistency, and test-retest reliability.

Patients with metastatic colorectal cancer (mCRC) undergoing systemic treatment often experience toxicities. Although exercise may improve physical fitness and quality of life and counteract treatment toxicity, knowledge in patients with mCRC is limited. The ongoing randomized controlled AMICO trial evaluates the effects of supervised exercise on clinical outcomes. The present qualitative study was a pre-planned part of this trial aiming to capture adherence, satisfaction, and perceived effects of exercise among patients with mCRC.

Patients with mCRC receiving first-line systemic treatment were randomized (1:1:1) to a control group or one of two supervised exercise arms including continuous aerobic exercise with either resistance exercises or high-intensity interval training. Semi-structured interviews with patients in the exercise arms were transcribed verbatim and thematically analyzed. Descriptive data on adherence (exercise logs) and satisfaction (questionnaire) was collected to complement and contextualize the qualitative findings.

Twenty-one patients were interviewed. Median exercise attendance was 67% [IQR 35-91], and the median satisfaction score was 8 [IQR 8-9] out of 10. Patients valued the guidance and knowledge of the physical therapist and expressed interindividual preferences regarding training content. Patients experienced that exercise improved their physical and mental wellbeing and helped them to endure treatment. Perceived exercise barriers were treatment toxicity, physical problems, and hospital appointments. Perceived exercise facilitators included adequate tailoring and internal or external motivation.

Patients with mCRC appreciated exercise during systemic treatment and perceived several beneficial effects, both physically and mentally. Exercise attendance varied and barriers were mainly treatment- and disease-related.

Clinical trial.

NCT04754672. Date of registration: 04-12-2020.

To evaluate cancer patients' willingness to pay for exercise services and oncology health professionals' perception of patients' willingness to pay.

A mixed-methods design was used. Online questionnaires and semi-structured interviews were administered to people with any type of cancer and oncology health professionals delivering clinical care. Questionnaires assessed patients' willingness to pay for one consultation with a cancer-trained exercise specialist (i.e. exercise physiologist/physiotherapist) and regular group exercise sessions supervised by cancer-trained exercise specialists. Interviews probed factors associated with the out-of-pocket cost of adopting exercise guidelines. Data were analysed using standard descriptive statistics and an interpretive descriptive approach to qualitative analysis.

Participants included 450 cancer patients and 300 oncology health professionals. A randomly selected sub-set of 30 patients and 31 health professionals completed interviews. The majority of patients surveyed would pay for an exercise consultation (94%) and regular group exercise sessions (58.4% extremely likely; 24.7% moderately likely; standard 7-point Likert scale response options). A greater proportion of patients who were employed (97.2% p = 0.030), below average general health (97.0% p = 0.031), were female (96.1% p = 0.013), and insufficiently active (95.3% p = 0.048) were willing to pay for exercise services. Oncology health professionals perceived fewer patients would be willing to pay for exercise services (p < 0.001; consultation = 7.0% extremely likely, 32.7% moderately likely; regular supervised sessions = 5.3% extremely likely; 32.0% moderately likely).

When briefly informed of the benefits and costs of exercise, the majority of patients in this study would pay for cancer-specific exercise services. There is an opportunity to align perceptions of willingness to pay among patients and health professionals involved in their care to help facilitate the uptake of exercise guidelines.

The digital phenotyping tool has great potential for the deep characterization of neurological and quality-of-life assessments in brain tumor patients. Phone communication activities (details on call and text use) can provide insight into the patients' sociability.

We prospectively collected digital-phenotyping data from six brain tumor patients. The data were collected using the Beiwe application installed on their personal smartphones. We constructed several daily sociability features from phone communication logs, including the number of incoming and outgoing text messages and calls, the length of messages and duration of calls, message reciprocity, the number of communication partners, and number of missed calls. We compared variability in these sociability features against those obtained from a control group, matched for age and sex, selected among patients with a herniated disc.

In brain tumor patients, phone-based communication appears to deteriorate with time, as evident in the trend for total outgoing minutes, total outgoing calls, and call out-degree.

These measures indicate a possible decrease in sociability over time in brain tumor patients that may correlate with survival. This exploratory analysis suggests that a quantifiable digital sociability phenotype exists and is comparable for patients with different survival outcomes. Overall, assessing neurocognitive function using digital phenotyping appears promising.

Exercising during cancer treatment reduces fatigue, improves quality of life, and increases survival, yet 60-70% of Australians undergoing cancer treatment do not meet current physical activity (PA) recommendations. This study aimed to explore barriers and enablers to PA amongst people undergoing cancer treatment and develop a video resource targeting these barriers.

The study was guided by the capability, opportunity, motivation, behaviour (COM-B) and behaviour change wheel (BCW) frameworks. Focus groups were conducted with people undergoing cancer treatment. Thematic analysis of qualitative data generated themes representing barriers and enablers to PA which were mapped to behaviour change techniques (BCTs) and incorporated into a video.

Four focus groups were conducted with 15 participants (mean age 57, range 21-75). Eighteen themes were generated and mapped to six domains of the COM-B. The main barriers to exercise were physical (cancer-related fatigue), psychological (fear of overexertion), and inconsistent messaging. Enabling factors included accessible information about PA and incorporating PA into the care plan. Six BCTs were identified: information about health consequences; information about emotional consequences; demonstration of the behaviour; social comparison; information about others' approval; and credible source. These were incorporated into the production of an 11-minute video.

This research facilitated development of a novel, theory-informed video aimed at improving uptake of PA amongst people undergoing cancer treatment. Evaluating the acceptability and effectiveness of the video is needed to support implementation of this intervention into standard care.

Incorporating BCTs into a video promoting PA may enhance PA uptake and health outcomes for people undergoing cancer treatment.

Pain is one of the most common symptoms of cancer patients, affecting the patient's physical, psychological, behavioral, social relations and other aspects. Previous studies have demonstrated that exercise is effective for cancer pain, and the optimal exercise is still unknown.

This study aimed to compare the effects of different exercise interventions on cancer pain in adults.

Randomized control trials identified from medical literature databases that reported effects of exercise in adults with cancer pain were included in this study. Literature screening and data extraction were conducted independently by 2 researchers. Cochrane Bias Assessment 2.0 was used to assess the quality of the literature, and Stata 15.0 software was used for Network meta-analysis.

Forty-one studies were included, involving 3537 patients with cancer pain. The types of exercise involved included aerobic exercise, medium intensity continuous training, high-intensity interval training, resistance exercise, mind-body exercise and comprehensive exercise program (CEP). The results suggested that CEP was more effective than the usual care in relieving pain intensity in cancer patients [SMD = -1.96,95% CI (-3.47, -0.44)] (SUCRA = 97.9%). Mind-body exercise outperformed usual care in reducing pain interference in cancer patients [SMD = -0.65, 95% CI (-1.21, -0.09)] (SUCRA = 83.8%).

Current evidence shows that CEP is the best way to relieve the pain intensity of cancer patients, and mind-body exercise is the best way to reduce pain interference of cancer patients. Due to the limited number and quality of the included studies, the above conclusions need to be further verified by more high-quality studies.

Aromatase inhibitor is associated with a high incidence of Aromatase Inhibitor-Associated Musculoskeletal Syndrome (AIMSS) in postmenopausal women with hormone-sensitive breast cancer.

This scoping review aims to identify available information regarding the frameworks, models, or strategies of adapted physical activity (APA) programs implemented for the prevention and management of AIMSS.

Search was realized by two independent reviewers in six databases following PRISMA-ScR guidelines. Data of included articles were extracted, and risk of bias analyzed.

Finally, 14 were included. No study has examined APA in the prevention of AIMSS. There is no solid evidence supporting the impact of APA on the management of AIMSS. However, evidence suggests that an APA program can reduce the worst joint pain and improve the quality of life.

Future research will enlighten clinical practices with the development of personalized APA programs in hormone-sensitive breast cancer.

The reduced cardiorespiratory fitness (CRF) and functional capacity following surgical procedures and during cancer treatments is a major risk factor for morbidity and mortality among patients with cancer. We aimed to assess the impact of endurance and combined resistance exercise interventions during the postoperative rehabilitation period for patients with colorectal, breast, and prostate cancer.

A systematic search was conducted in MEDLINE Pubmed, Web of Science, and Cochrane Library until October 2023 for randomized controlled trials that assessed exercise interventions (aerobic/endurance; resistance or combined training) on postoperative patients with cancer. The trials evaluated the change in oxygen uptake (VO2max), six-minute walking distance (6MWD), quality of life (QoL), and fatigue.

Twelve studies, including 1298 patients, were part of this systematic review, and ten studies were included in the meta-analysis. Postoperative exercise interventions led to improvements in CRF and functional capacity (VO2max: MD 1.46 ml/kg/min; 95%-CI 0.33, 2.58; p  = 0.01; 6MWD: MD 63.47 m; 95%-CI 28.18, 98.76; p = 0.0004, respectively) as well as QoL (0.91; 95%-CI 0.06, 1.76; p = 0.04). The quality of evidence was moderate to low.

Postoperative exercise interventions could effectively improve CRF, functional capacity and QoL as shown in this meta-analysis. However, there is a lack of high-quality trials with a higher number of participants examining the effects of postoperative exercise in patients with colorectal, breast, and prostate cancer. There is an obvious need for long-term, cancer-specific exercise therapies and their evaluation in cancer care.

Cancer survivors (CS) often experience treatment-related side effects, such as fatigue, and have reduced physical function. Regular physical activity has been demonstrated to reduce these symptoms and improve cardiopulmonary fitness. Digital solutions are needed to optimize exercise options for CS in aftercare, especially given the significant limitations during the Covid-19 pandemic. This two-armed, non-randomized, controlled intervention study for CS aims to investigate whether a telemedicine-based exercise intervention is as effective as the current standard of care for oncological exercise therapy in aftercare. Patients in the intervention group (n = 61) performed a telemedicine-based exercise program (TE) and patients in the control group (n = 31) participated in an existing rehabilitation sports group (RG) over a six-month intervention period. The primary outcome was cardiopulmonary fitness measured by VO2peak; secondary outcomes included quality of life (QoL), fatigue, and physical activity. A non-inferiority analysis was performed with a predefined non-inferiority margin for relative VO2peak of -1.50 ml/min/kg. Although TE demonstrated a slight advantage in relative VO2peak compared to RG (adjusted mean difference of 0.55 ml/min/kg [95% CI: -2.74; 3.84]), the non-inferiority was not statistically significant. Nevertheless, the implementation of a telemedicine-based exercise intervention indicates that individual patients respond well to this type of exercise program and benefit from the intervention, particularly in terms of QoL. Finding an individualized program for each cancer survivor is the overarching goal. A telemedicine-based exercise intervention may be a promising option, particularly for younger patients.

We aimed to identify metastatic breast cancer (MBC) patients' preferences for exercise programs and identify patients' characteristics associated with these preferences, to facilitate implementation of exercise programs for MBC patients.

We used data from a multinational cross-sectional survey conducted among MBC patients. Patients reported their preferred exercise frequency, intensity, type, session duration, and supervision mode. We used latent class analysis to identify subgroups with similar preferences and descriptive statistics to compare demographic and clinical characteristics of patients within subgroups.

Four distinct classes were identified based on data from 409 participants. Class 1 (47% of participants) is characterized by a preference for moderate exercise with supervision within the health care setting. Most participants in this class had bone metastases. Class 2 (30%) is characterized by a preference for vigorous exercise with supervision. This class included participants who were, on average, younger, and had a higher education level. Class 3 (13%) is characterized by a preference for active walking. These participants were less likely to have bone metastases or comorbidities. Class 4 (10%) is characterized by a preference for recreational walking and included participants who were, on average, older, and less likely to be employed.

We identified four classes of patients with different preferences for exercise programs. Many patients with MBC express exercise preferences that meet the current guideline recommendations. Some patients with MBC may benefit from targeted education to align their preferences and behavior with the amount of exercise that is necessary to gain health benefits.

Strong evidence supports the benefits of exercise following both cardiovascular disease and cancer diagnoses. However, less than one-third of Australians who are referred to exercise rehabilitation complete a program following a cardiac diagnosis. Technological advances make it increasingly possible to embed real-time supervision, tailored exercise prescription, behavior change, and social support into home-based programs.

This study aimed to explore demographic and health characteristics associated with the likelihood of breast cancer survivors uptaking a digitally delivered cardiac exercise rehabilitation program and to determine whether this differed according to intervention timing (ie, offered generally, before, during, or after treatment). Secondary aims were to explore the knowledge of cardiac-related treatment side-effects, exercise behavior, additional intervention interests (eg, diet, fatigue management), and service fee capabilities.

This cross-sectional study involved a convenience sample of breast cancer survivors recruited via social media. A self-reported questionnaire was used to collect outcomes of interests, including the likelihood of uptaking a digitally delivered cardiac exercise rehabilitation program, and demographic and health characteristics. Descriptive statistics were used to summarize sample characteristics and outcomes. Ordered logistic regression models were used to examine associations between demographic and health characteristics and likelihood of intervention uptake generally, before, during, and after treatment, with odds ratios (ORs) <0.67 or >1.5 defined as clinically meaningful and statistical significance a priori set at P≤.05.

A high proportion (194/208, 93%) of the sample (mean age 57, SD 11 years; median BMI=26, IQR 23-31 kg/m2) met recommended physical activity levels at the time of the survey. Living in an outer regional area (compared with living in a major city) was associated with higher odds of uptake in each model (OR 3.86-8.57, 95% CI 1.04-68.47; P=.01-.04). Receiving more cardiotoxic treatments was also associated with higher odds of general uptake (OR 1.42, 95% CI 1.02-1.96; P=.04). There was some evidence that a higher BMI, more comorbid conditions, and lower education (compared with university education) were associated with lower odds of intervention uptake, but findings differed according to intervention timing. Respondents identified the need for better education about the cardiotoxic effects of breast cancer treatment, and the desire for multifaceted rehabilitation interventions that are free or low cost (median Aus $10, IQR 10-15 per session; Aus $1=US $0.69 at time of study).

These findings can be used to better inform future research and the development of intervention techniques that are critical to improving the delivery of a digital service model that is effective, equitable, and accessible, specifically, by enhancing digital inclusion, addressing general exercise barriers experienced by chronic disease populations, incorporating multidisciplinary care, and developing affordable delivery models.