Table 1 Operational definition of implementation outcomes applied in review

Acceptability

The perception among implementation stakeholders that a given treatment, service, practice, or innovation is agreeable, palatable, or satisfactory.

The degree to which the patient or healthcare workforce find the exercise intervention satisfactory as measured by the patient or healthcare workforce.

Adoption

The intention, initial decision, or action to try or employ an innovation or evidence-based practice

Any measure that reports on the uptake of exercise intervention as reported by the healthcare staff (for example, total number of staff making referrals to exercise) or organisation; this may include barriers and enablers.

Appropriateness

The perceived fit, relevance, or compatibility of the innovation or evidence-based practice for a given practice setting, provider, or consumer; and/or perceived fit of the innovation to address a particular issue or problem.

Exercise interventions are implemented because there is a specific, documented rationale that indicates the intervention is relevant to that patient population, based on clinical trials effectiveness (for example, reference to a successful efficacy trial that the current exercise intervention is based upon).

Cost

Cost (incremental or implementation cost)

The cost impact of an implementation effort according to three components: i) cost of delivering the intervention, ii) cost of the specific implementation strategy and iii) the delivery cost according to the setting

The documented cost of implementing the exercise intervention in healthcare settings. This includes costs incurred by healthcare organisations such as human and physical/practical resources, or costs associated with use of the intervention.

Feasibility

The extent to which a new treatment, or an innovation, can be successfully used or carried out within a given agency or setting

Intervention attendance and/or attrition rates for the program.

Fidelity

The degree to which an intervention was implemented as it was prescribed in the original protocol or as it was intended by the program developers

The exercise intervention is delivered as described in the documented pre-implementation plan or intervention protocol; if adaptations (tailoring) are required, these are reported either qualitatively or quantitatively.

Penetration

The integration of a practice within a service setting and its subsystems

Patients referred to the intervention reported with consideration to total eligible patient population (for example intervention reach data).

Sustainability

The extent to which a newly implemented treatment is maintained or institutionalized within a service setting’s ongoing, stable operations

Documented evidence that the exercise intervention has been integrated within normal organisational operations (for example, reference to polices, hiring staff, documented care pathways) and the long-term (> 12 months) health outcomes of the exercise intervention on adverse treatment-related side effects (such as fatigue, quality of life, physical function and/or symptoms of depression).

Whilst Proctor and colleague’s definition of sustainability does not include a measure of clinical effect, it is added as a secondary outcome in this review. This decision was made to confirm that the exercise intervention continues to deliver the intended health benefits that it was implemented to address.