Oncology exercise group fills the gap

 

A desire to improve the wellbeing of people living with cancer has inspired two physiotherapists in the Tasmanian Health Service to develop a free group-based exercise program.

Since February, the Oncology Exercise Group (OEG) has been running twice a week for eight weeks for people who are deconditioned as a result of their cancer or treatment. It is open to people before, during or up to one year after treatment. Initial outcomes for patients are positive, with 50 referrals since launch.

Program organisers Charlotte Blake and Trena Youngblutt are hopeful that initial data will secure the program’s future beyond its slated September finish. They launched OEG to meet a service gap in providing cancer patients with a low-cost, evidence- based oncology exercise option.

‘There is a wealth of evidence showing that exercise can improve physical function, fatigue, psychological distress and quality of life,’ Charlotte says. ‘Research shows that most people with cancer decrease physical activity levels between diagnosis and treatment, with the Clinical Oncology Society of Australia (COSA) reporting that only 10 to 20 per cent meet resistance guidelines and 30 to 40 per cent meet aerobic guidelines.’

Charlotte’s interest in the role exercise could play in improving patient outcomes and quality of life was piqued when doing a rotation in Royal Hobart Hospital’s inpatient oncology ward.

‘After doing some research and learning of the high level of evidence for exercise as therapy in this population, I wanted to refer people to a community-based group that could offer support and structured exercise,’ Charlotte says. ‘However, no such group existed that was accessible, either due to financial or other reasons. Trena is a senior community physiotherapist and after I shared this observation with her we decided to look for opportunities to broaden the scope of the Southern Physiotherapy Department to fulfil this service gap.’

COSA guidelines recommend oncology patients undertake 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic exercise, plus two to three resistance exercise sessions per week. Each one-hour OEG class is tailored to individual needs and level of fitness. Before starting, each participant has a one-on-one assessment to establish a personalised, goal-based exercise program. Of the 50 patient referrals, 29 have started the classes (58 per cent of total referrals), with 20 on track to complete the program, so far.

‘Our goal is to help patients improve their physical activity habits toward the recommended guidelines. The group offers them a chance to explore the benefits of exercise in a friendly, supportive place. We try and foster an element of peer learning and support through monthly “chat” sessions where we discuss exercise- related topics such as motivation, barriers and how to overcome them. Participants will often help each other out with setting up equipment and end up sharing their stories,’ Charlotte says.

‘Some of the reasons why people who are referred do not start or complete the program include being too unwell— fatigue is a common reason—or being unable to access it due to location, transport or having multiple medical appointments, which can give a feeling of being overwhelmed.’

Physical outcomes measured include a six-minute walk test (6MWT), 30-second sit-to-stand, grip strength and 10RPM (repetitions per minute) bicep curl. As of June, measured outcomes showed 71 per cent of participants had significant improvement (>30 metre change) for the 6MWT, 64 per cent of participants had improvement (no clinically significant standardised measure) in grip strength, 100 per cent of participants had improvement (no clinically significant standardised measure) for the bicep 10RPM, and 85 per cent of participants had improvement (no clinically significant standardised measure) for the 30-second sit-to-stand.

‘We also collect QOL and fatigue data, but these haven’t shown consistent significant improvement to date, but this may be complicated by high baseline measures in most participants,’ Charlotte says. ‘At this stage a lot of our referrals are for people who are at relatively high levels of functioning, but my hope would be that as referrers become more familiar with the program we will see people being referred earlier in their disease or treatment.

‘Patient satisfaction rates with the program are high, with all participants reporting 8.5 out of 10 satisfaction or higher. At completion, 100 per cent of participants are meeting COSA guidelines, and we plan on completing follow-up phone calls at three months post-program to see if this is maintained.’

The program is a subproject of the Statewide Subacute Care Project (GEM and Rehabilitation) and is federally funded through the National Partnership Agreement on Improving Health Services in Tasmania. Trena and Charlotte triage referrals, and undertake assessments and reassessments, with support from the Community Team of Physiotherapy Services Tasmanian Health Service—South.

‘We often get help from other physios and allied health assistants to cover if one of us is on leave,’ Charlotte says. ‘Trena is often quoted as saying that running the group is her favourite part of the week—she leaves feeling happy and energised, and we couldn’t have made the program happen without the support of our physiotherapy management team.’

Charlotte says a key component of the program is upskilling the community physiotherapy workforce. ‘We want to empower allied health professionals with confidence to help people with cancer get more active. As we are part of the public service we have strong links to the oncology team at the Royal and can provide good continuity of care and communication pathways.’

With positive feedback from patients and input from allied health professionals, Charlotte is optimistic the program will be given the green light to transition to an ongoing part of the physiotherapy service and undergo further development. ‘Patients are commenting about improvements to their overall wellbeing and increased exercise tolerance. My hope is that eventually everyone would be involved—oncologists, cancer nurses, allied health—and that with multidisciplinary support and enthusiasm the potential for a true oncology rehabilitation program could eventually evolve,’ she says.

‘I think having an exercise physiologist involved would be fantastic given their skills in exercise prescription and design, and a physio–EP duo could be a powerful force, with skills that complement each other well.’

 

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