P-156\u2005Mixed-method study of exercise in advanced cancer: multiple views on adherence and lasting behaviour

Abstract

Introduction Research suggests exercise can provide numerous benefits for people with advanced cancer. Reported benefits include improved physical performance (Temel, Greer, Goldberg, Vogel, et al, 2009; Bourke, Doll, Crank, Daley, et al., 2011; Oldervoll, Loge, Lydersen, Paltiel et al., 2011; Quist, Rorth, Langer, Jones et al., 2012; Cheville, Kollasch, Vandenberg, Shen et al., 2013; Cormie, Newton, Spry, Joseph et al., 2013; Litterini, Fieler, Cavanaugh & Lee, 2013; Jensen, Baumann, Stein, Bloch et al., 2014; Rief, Petersen, Omlor, Akbar et al., 2014; Quist, Adamsen, Rorth, Laursen et al., 2015) improved psychological wellbeing (Quist, Rorth, Langer, Jones et al., 2012; Quist, Adamsen, Rorth, Laursen et al., 2015; Burke, Brunet, Sabiston, Jack et al., 2013; Rief, Akbar, Keller, Omlor et al., 2014), reduced fatigue (Bourke, Doll, Crank, Daley et al., 2011; Cheville, Kollasch, Vandenberg, Shen et al., 2013; Litterini, Fieler, Cavanaugh & Lee, 2013; Jensen, Baumann, Stein, Bloch et al., 2014; Burke, Brunet, Sabiston, Jack et al., 2013; Rief, Akbar, Keller, Omlor et al., 2014), increased completion of planned treatments (Cheville, Alberts, Rummans, Bashford et al., 2015), and fewer hospital admissions (Cheville, Alberts, Rummans, Bashford et al., 2015). Much of the research into exercise in advanced cancer has involved supervised sessions in specialist settings (Temel, Greer, Goldberg, Vogel et al., 2009; Oldervoll, Loge, Lydersen, Paltiel et al., 2011; Litterini, Fieler, Cavanaugh & Lee, 2013; Jensen, Baumann, Stein, Bloch et al., 2014; Quist, Adamsen, Rorth, Laursen et al., 2015; Burke, Brunet, Sabiston, Jack et al., 2013; Cheville, Alberts, Rummans, Bashford et al., 2015). Limited healthcare resources mean exercise interventions delivered under these specialist conditions may not be deliverable across a larger population in standard healthcare settings. Attempts to address this have combined supervised hospital-based sessions with less resource intensive unsupervised home-based sessions. However, several studies have reported a large drop in adherence during the unsupervised exercise (Quist, Rorth, Langer, Jones et al., 2012; Kuehr, Wiskemann, Abel, Ulrich et al., 2014; Winters-Stone, Dobek, Bennett, Maddalozzo et al., 2014; Winters-Stone, Dobek, Bennett, Dieckmann et al., 2015). Reasons for the decline in adherence to the unsupervised home-based sessions have not been thoroughly investigated. Aim To investigate factors that influence exercise adherence in a series of supervised exercise classes in a hospice day service, and investigate continuing exercise behaviour after class completion. Methods and analysis People with advanced cancer (n=11), enrolled in a hospice day care exercise class, took part in semi-structured interviews at two time points. Firstly during the supervised class period, secondly six weeks post class completion. At both time points participants also completed a validated questionnaire (Kirby, Donovan-Hall & Yardley, 2014) which measured factors perceived to have impeded exercise. All staff who delivered the classes (n=4) also participated in one semi-structured interview. Interview data will be analysed using the framework approach (Richie & Spencer, 1994; Smith & Firth, 2011; Spencer, Ritchie, Ormston, O’Connor et al., 2014) to gain knowledge in relation to the identified study aims. The questionnaire will be analysed using descriptive statistics, to show central tendency and dispersion of factors perceived to have prevented exercise. Results Data collection has been completed. Data analysis is underway. Conclusion Findings will create a set of recommendations, for intervention designers, to maximise adherence to unsupervised exercise for people with advanced cancer. The recommendations will intend to be applicable in both clinical practice and research settings.