Table 3 Characteristics of included studies

Beidas

2014

Effectiveness/

Implementation

n = 84 (effectiveness)

n = 19 (implementation)

Adoption

Healthcare Provider

Community (specialist exercise clinic) + Home

Breast cancer

What (materials) - Power blocks adjustable dumbbells

Who (qualifications) – Physiotherapist

How (delivery) - One physiotherapist to 7 or fewer survivors;

Exercise logs used for self-reported adherence monitoring

When, how much (dosage) - 4 small group PT sessions completed over 1–2 months + 2x/wk. home resistance training

Tailoring – Individualized

Appropriateness

Intervention

Cost

Intervention

Bjerre

2018

Effectiveness

n = 214

(n = 109 intervention

n = 105 control)

Appropriateness

Intervention

Community (fitness centre)

Prostate cancer

What (materials) – Not reported

Who (qualifications) – Local football coaches who underwent 8–10 h of training in intervention and cancer

How (delivery) – Group football training

When, how much (dosage) - 6 months of recreational football for 1 h 2x/wk. Football sessions lasted 1 h and included 20 min of warm up and 20 min each of drills and match play

Cost

Intervention

Feasibility

Patient

Fidelity

Healthcare provider

Bjerre

2019

Effectiveness

n = 214

(n = 109 intervention

n = 105 control)

Appropriateness

Intervention

Community (fitness centre)

Prostate cancer

See Bjerre 2018

Bultijnck

2018

Implementation

n = 98

Adoption

Organisation

Hospital (not stated if inpatient or outpatient)

Prostate cancer

Characteristics of exercise program were reported for general cancer rehabilitation programs and prostate cancer specific programs. Below is a summary of both program types:

General

What (materials) – NA

Who (qualifications) - NA

How (delivery) - 73.3% were group training, 57.8% started after treatment

When, how much (dosage) - Most programs included aerobic and resistance components of between 60 and 90 min duration conducted 2x/wk. 42.2% of programs conducted 24 sessions.

Tailoring - NA

Prostate cancer specific programs

What (materials) – NA

Who (qualifications) - NA

How (delivery) - 77.8% were group training, 38.9% started during treatment

When, how much (dosage) - 100% of programs included aerobic and resistance components and approx. Half also included flexibility and pelvic training, 50% were 90 min in duration and most commonly conducted 2x/wk. 61.1% of programs conducted 48 sessions.

Tailoring - NA

Brown

2019

Effectiveness

n = 183

Feasibility

Patient

Community (specialist exercise clinic)

Any cancer type

What (materials) - Treadmill, cycle ergometer, NuStep, Aquaciser (underwater treadmill), and outdoor walking or jogging. Cybex® resistance machines, resistance bands, dumbbells, medicine balls, body weight, and resistance tubing

Who (qualifications) – Certified Clinical Cancer Exercise Specialists (CCES)

How (delivery) - Individual sessions

When, how much (dosage) - Each phase (a total of 3 phases + 1 phase of infinite duration) was 3x/wk. for 12 wks. Duration was 60 min per session (20 min aerobic, 30 min resistance (3 × 10 reps), 10 min for flexibility training, and balance exercises incorporated throughout. Intensity increased from low/mod to high as Phases progressed.

Tailoring - Individualized based on patient assessment

Fidelity

Healthcare provider

Cheifetz

2014

Effectiveness/

Implementation

n = 115 (effectiveness)

Fidelity

Healthcare Provider

Community (fitness centre)

Any cancer type

What (materials) -Not reported

Who (qualifications) - YMCA staff who undergo specific training lead by physiotherapist or nurse

How (delivery)- Group training, peer support encouraged

When, how much (dosage) - 12 wk. program, 2x/wk. supervised + 1x/wk. independent exercise. Includes aerobic (target HR 50–80% MHR), muscle strength (2–3 sets, 12 repetitions) and flexibility based on established guidelines (i.e. ACSM)

Tailoring - Programs are tailored and individualized on the basis of baseline testing, unique cancer type and stage and person specific precautions and contraindications.

Feasibility

Patient

Cheifetz

2015

Effectiveness/

Implementation

n = 57 (effectiveness)

n = 12 (implementation)

Feasibility

Patient

Community (fitness centre)

Any cancer type

See Cheifetz 2014

Culos-Reed

2018

Effectiveness/Implementation

n = 58 (effectiveness)

Appropriateness

Intervention

Community (specialist exercise clinic and fitness centre)

Prostate cancer

What (materials) -Exercise that can be completed with minimal equipment (exercise bands and balls, body weights and free weights)

Who (qualifications) - Credentialed health and fitness professionals

How (delivery)- Group training. Maximum ratio 1 facilitator per 15 participants.

When, how much (dosage) - 12-wk program (with an additional 12-wk maintenance phase), 60 min per session, completed 2x/wk. of 1-h duration. A combination of mild to mod/somewhat hard-intensity aerobic and resistance training, or gentle yoga with cooldown and meditation (i.e. savasana). Group exercise consists of 3–4 exercises in a circuit with adapted plyometric aerobic exercise.

Tailoring - All exercises are adapted to accommodate individuals’ preferences and limitations

Cost

Intervention

Feasibility

Patient

Fidelity

Healthcare Provider

Culos-Reed

2019

Implementation

n = 11

Cost

Intervention

Community (specialist exercise clinic and fitness centre)

Prostate cancer

See Culos-Reed 2018

Dalzell

2017

Implementation

n = 1635 (referred over the duration)

Adoption

Cost

Organisation

Organisation

Hospital (out-patient) + Community (specialist exercise clinic) + Home

Any cancer type

What (materials) - Not reported

Who (qualifications) - Varied depending upon triage of patients

How (delivery)- Varied depending upon triage of patients

When, how much (dosage) - ACSM exercise guidelines for cancer survivors and included components of flexibility, cardiovascular, and resistance training whenever possible. Focused on increasing physical activity levels and included a combination of home exercise, wellness centre–based training, or participation in exercise classes.

Tailoring – Individualized programs with re-assessment every 3 months.

Dennett

2017

Implementation

n = 31 (exercise oncology programs)

n = 15 (providers)

Adoption

Healthcare Provider

Hospital (in and outpatient) + Community (specialist exercise clinic)

Not reported

What (materials) - Not reported

Who (qualifications) - Supervised (by physiotherapists or exercise physiologists)

How (delivery) - Typically conducted in a group based upon an initial individualized assessment.

When, how much (dosage) - Included aerobic, resistance and flexibility exercises. Exercise outside the program was encouraged with most suggesting aerobic exercise 4-5x/wk. and resistance exercise 2-3x/wk. Strategies used to encourage compliance with home exercise included written home exercise programs and referrals to community groups.

Tailoring - Programs are typically individualized, monitored throughout and progressed.

Dolan

2018

Effectiveness

n = 152 (files)

Appropriateness

Intervention

Community (specialist exercise clinic)

Breast cancer

What (materials) - free weights, body weight, and/or elastic bands

Who (qualifications) - cardiac rehabilitation supervisor + 2 exercise assistants

How (delivery)- Group program (15 patients)

When, how much (dosage) - supervised exercise (dynamic warmup, aerobic training (walking commence at 1 mile and increase to 3 miles (walk/jog) starting at 60%VO₂ reserve with fitter individuals starting at 80%VO₂ reserve), strength training (2 × 10 reps of 12 full-body exercises), and cool-down) with 12 education seminars. 22 sessions 1x/wk. for the duration of the program. In addition to the weekly supervised exercise session, unsupervised activities (up to 2 strength and 4 aerobic sessions /wk) were promoted through education and goal setting. Peer mentoring supported

Tailoring - Individualized according to current guidelines and initial baseline fitness test results

Feasibility

Patient

Haas

2011

Implementation

NA

Adoption

Organisation

Community (fitness centre)

Any cancer type

What (materials) - Dumbbell weights

Who (qualifications) - unclear - clinical personnel complete initial assessment

How (delivery) - Unclear

When, how much (dosage) - Aerobic exercise, stretching, upper body weight-lifting exercises + 1 core exercise (squats or stability ball). Activity plan developed and a follow-up exercise schedule established. Participants are encouraged to exercise at least 3x/wk. and increase exercise intensity or duration by 10 to 15% each wk.

Tailoring - Individualized according to current guidelines and initial baseline fitness test results. Activity is ceased during sessions on self-reported mild fatigue

Cost

Organisation

Feasibility

Patient

Haas

2012

Effectiveness

n = 177

Feasibility

Patient

Community (fitness centre)

Any cancer type

See Haas 2011

Pedometers were provided

Sustainability

Patient + Organisation

Heston

2015

Implementation

n = 1591 (providers)

n = 1668 (participants)

Adoption

Organisation

Community (fitness centre)

Not reported

What (materials) - Not reported

Who (qualifications) - YMCA staff trained in LIVESTRONG

How (delivery)- small-group (6–16 participants)

When, how much (dosage) - Adheres to ACSM guidelines. 12-wk duration, 2 sessions/wk. (75 min session) including aerobic fitness, muscle mass and strength, flexibility and balance. Peer-to-peer support included.

Tailoring - Instructors created individualized physical activity plan

Cost

Intervention + Organisation

Feasibility

Patient

Fidelity

Healthcare Provider

Irwin

2017

Effectiveness

n = 186

(n = 95 intervention

n = 91 control)

Adoption

Organisation

Community (fitness centre)

Any cancer type

See Heston 2015

Feasibility

Patient

Kimmel

2014

Implementation

NA

Adoption

Organisation

Community (fitness centre)

Any cancer type

See Haas 2011

After a few months move to 6 to 10 participants per staff member.

Feasibility

Patient

Kirkham

2016

Effectiveness

n = 163

Cost

Intervention

Hospital (out-patient)

Any cancer type

What (materials) - Nautilus system

Who (qualifications) - 2 exercise physiologists + other health professional

How (delivery)- Group-based

When, how much (dosage) - 2 x/wk. for 12 wks (24 sessions) with optional education class 1 days per wk. Classes were 60 min in duration and included 20–30 min of aerobic exercise (intensity individualized but between 40 and 80% HHR) + 15–20 min of resistance exercise (8–10 reps increasing to 3 sets before increasing weights, exercise included bicep curl, triceps extension, vertical press, chest press, rows, leg extension, leg curl, leg press, lat pulldown

Tailoring - Individualized as required

Feasibility

Patient

Kirkham

2018

Effectiveness

n = 73

Acceptability

Patient

Community (specialist exercise clinic) + Home

Breast cancer

What (materials) - Treadmill, elliptical, upright or recumbent cycle ergometer, resistance machines and dumbbells,

Who (qualifications) - Lead by local university (lead exercise trainer, graduate exercise trainer, volunteer kinesiology student)

How (delivery)- community base program was combined with home-program

When, how much (dosage) - Included aerobic and resistance exercise (e.g. press, leg curls, calf raises, chest press, and seated row on machine; triceps extensions and biceps curls using dumbbells; two core-strengthening exercises). Program commenced with supervised 3x/wk. (length of chemotherapy, plus radiation if received) then reduce to 2x/wk. for 10 wks and then 1x/wk. for 10 wks during maintenance phase.

Tailoring - Individualized as required; Aerobic component commenced at 20 min and increased to 30 min duration after wk. 4 (Progressive from 50 to 70% of APMHR HRR over wks 1–8, 70–75% for wks 9). Resistance commenced at 1 × 10 and then increased to 2 × 10–12 for remaining program (Chest and leg press: 50%

estimated 1-RM, Similar RPE for all other exercises Weights were progressed every 4 wks up to 75% of 1-RM).

Appropriateness

Intervention

Cost

Organisation + Patient

Feasibility

Patient

Penetration

Organisation

Kirkham

2019

Effectiveness

n = 73

Appropriateness

Intervention

Community (specialist exercise clinic) + Home

Breast cancer

See Kirkham 2018

Leach

2014

Implementation

Not reported

Adoption

Organisation

Community (specialist exercise clinic) + Home

Breast cancer

What (materials) - Not reported

Who (qualifications) - Initial assessment by certified exercise physiologists

How (delivery) - Option of home-based or community-based (group)

When, how much (dosage) - 2 days aerobic (40–60% APMHR for 20–60 min), 1 day of resistance exercise (varies between 1 and 3 sets of 8–12 repetitions and 5–14 exercises depending on difficulty level) and 5–7 days of flexibility exercise/wk. Participants are provided with 3 levels of difficulty (easy, medium, hard). Home-based exercisers are given resources that includes pictures and descriptions of all exercises and complete a fitness log to track adherence.

Tailoring - Self-administered tailoring

Leach

2015

Effectiveness

n = 80

Acceptability

Patient

Community (specialist exercise clinic) + Home

Breast cancer

See Leach 2014

Feasibility

Patient

Leach

2016

Effectiveness

n = 63 (maintenance phase)

Feasibility

Patient

Community (specialist exercise clinic) + Home

Breast cancer

See Leach 2014

Mackenzie

2013

Effectiveness

n = 66

Appropriateness

Intervention

Community (specialist exercise clinic)

Any cancer type

What (materials) - Not reported

Who (qualifications) - qualified yoga instructors

How (delivery) – group-based in community

When, how much (dosage) - 7 wk. program (1x75minute session). Combine initial breathing exercises, then 6–10 modified yoga poses, finish with relaxation exercise.

Tailoring - Individualized as required

Feasibility

Patient

Marker

2018

Effectiveness

n = 170

Cost

Intervention

Community (specialist exercise clinic) + Home

Any cancer type

What (materials) - Not reported

Who (qualifications) - Cancer Exercise Specialist or trained and supervised program interns completing a degree in Exercise Physiology or a related field

How (delivery) - Commence with 2–3 individual session and then small group exercise

When, how much (dosage) - Each session is 50 min in duration and commences with 10 min warm-up. Month one includes 2–3 individual sessions per wk., month two includes 2 group sessions (max 4 participants) per wk. and month three includes 1 group session per wk. Participants also receive unlimited access to the fitness facility during off-peak weekday hours and all day on weekends. Participants are provided with 3 levels of difficulty (easy, medium, hard). Home-based exercisers are given resources that includes pictures and descriptions of all exercises and complete a fitness log to track adherence. Exercise intensity during each session is highly adaptable and continuously adjusted

Tailoring - Individualized and tailored plans

Feasibility

Patient

Muraca

2011

Implementation

n = 51

Acceptability

Patient

Hospital (out-patient) + Home

Breast cancer

What (materials) - Pedometer and resistance band

Who (qualifications) - Fitness Professional (plus dietitian and social workers)

How (delivery)- Group + Home-based

When, how much (dosage) - 5x2hour sessions delivered over 10–12 wks. Includes a combination of diet, exercise and facilitated discussions to support behaviour change. A physical activity log is provided at the start of the program, DVD CD with 30 and 50 min audio coach-guided walking sessions. Recommendations include regular exercise initially 30 min 3–5 x/wk. Add resistance exercises

Tailoring - Individualized and tailored plans

Noble

2012

Effectiveness

n = 386

Feasibility

Patient

Community (specialist exercise clinic)

Any cancer type

What (materials) - Polar heart rate monitor, resistance program integrates a range of equipment

Who (qualifications) - Certified exercise physiologists

How (delivery) - Group-based

When, how much (dosage) - 2x/wk. for 1 h over 12 wks. Sessions include aerobic (progressively lengthened over 24 sessions and then increase intensity), resistance (15 reps increasing to 20 reps before weights are increased) and stretching/flexibility at the end of the session. No home exercise provided due to perceived risk.

Tailoring - Individualized and modified as required based upon patient presentation.

Rajotte

2012

Effectiveness

n = 221

Acceptability

Patient

Community (fitness centre)

Any cancer type

What (materials) – Not reported

Who (qualifications) - Personal trainer (ratio 1 trainer to 7 participants. Maximum 14 participants per group)

How (delivery) - Group-based

When, how much (dosage) - 2x/wk. for 12 wks (90-min sessions). 10-min aerobic warm-up, resistance exercise 50 min and 30 min ‘community building’ time. Participants and their immediate family receive a 12-wk YMCA membership. They can access the YMCA facilities on days other than the designated sessions and are encouraged to exercise outside the designated sessions.

Tailoring - Individualized

Appropriateness

Intervention

Rogers

2019

Implementation

n = 30

Adoption

Organisation

Community (specialist exercise clinic or fitness centre) + Home

Breast cancer

What (materials) – Not reported, however implementation toolkit is described that supports local adaptions based upon facilities

Who (qualifications) - fitness instructor or physiotherapist

How (delivery) – Combined group-based program with home exercises

When, how much (dosage) - 12 supervised sessions (10 in month one and 2 in month two), home-based exercise beginning in week 3 to work towards 150 min/wk. of mod/vig physical activity by the end of the 3-month intervention, coupled with 3 physical activity

counselling sessions (in-person or by telephone; one in month

2 and two in month 3), and 6 group discussions (three in

month 1, two in month 2, and one in month 3

Tailoring - Individualized

Appropriateness

Intervention

Cost

Organisation

Santa Mina

2012

Implementation

NA

Adoption

Organisation

Community (specialist cancer clinic) + Home

Any cancer type

What (materials) - exercise bands, a stability ball, and a yoga mat

Who (qualifications) - Multidisciplinary program (exercise component provided by certified exercise physiologist)

How (delivery) - primarily a home-based program but participants can participate in group-based sessions if desired

When, how much (dosage) - Home-based program, supported by adherence strategies (staff communicate (by telephone or e-mail) to address barriers, exercise manual that reinforces strategies for behaviour change, access to the weekly group exercise class to facilitate social support, access to educational seminar and psychologists to support behaviour change). Weekly group sessions are 90-min duration and include a 10-min warm-up, 20 min of low-impact aerobic exercise, 20 min

of resistance training, and 10 min of cool-down

Tailoring - Individualized

Cost

Organisation + Intervention

SantaMina

2017

Effectiveness

n = 229

Feasibility

Patient

Community (specialist cancer clinic)

Any cancer type

What (materials) - Example - arm ergometers, treadmills, stationary cycles, mini-trampolines, and elliptical machines and resistance bands, free weights, stability balls, body bars

Who (qualifications) - Physiotherapists, kinesiologists, or exercise physiologists who have completed an 8-h CancerSmart rehabilitation and exercise techniques course

How (delivery) - Group-based, 2 leaders per 8–10 participant

When, how much (dosage) - 30 wks exercise program (2x/wk. for 10 wks and then 1x/wk. for 20 wks). Each group session is 60 min in duration and includes aerobic interval training and resistance training, stretching, and balance exercises. Participants exercise at 50–80% of estimated heart rate range for 3–5 min and then move to musculoskeletal exercise. Cycle repeats 4–6 times with exercise recorded in patient logbook. Participants are encouraged to exercise independently, aiming to achieving 150 min of mod/vig physical activity per wk.

Tailoring - Individualized programs

Fidelity

Healthcare Provider

Santa Mina

2019

Effectiveness/Implementation

n = 207

Acceptability

Patient

Home + Hospital (out-patient)

Any cancer type

What (materials) - exercise mat, resistance bands, a stability ball, and a detailed exercise program manual

Who (qualifications) - Physiotherapist/Occupational Therapist (comprehensive assessment), Kinesiologists (exercise programming)

How (delivery)- individual with weekly group exercise class

When, how much (dosage) – aerobic component included recommendation for 150 min of mod/vig intensity/week Resistance component included 2–3 sessions/wk. of 4–10 exercises

Tailoring - Individualized programs

Adoption

Organisation

Appropriateness

Intervention

Sherman

2010

Effectiveness

n = 162

Acceptability

Patient

Community (fitness centre)

Breast cancer

What (materials) - heated swimming pool + separate room for floor-based exercise

Who (qualifications) - Encore coordinator

How (delivery)- Group-based

When, how much (dosage) - 1 × 8 wk. (2-h session). Sessions included low-intensity mobility and stretching exercises (20 min), and progressive hydrotherapy resistance exercises (30 min) with 5-min warm-up and cool-down. Participants are given home exercise sheets that they are encouraged to complete daily. This is reviewed weekly by the Encore coordinator.

Tailoring - Not reported

Adoption

Organisation

Feasibility

Patient

Speed-Andrews

2012

Effectiveness/Implementation

n = 23

Feasibility

Patient

Community (specialist exercise clinic or fitness centre)

Breast cancer

What (materials) - blocks, bolsters, straps, blankets

Who (qualifications) - licensed senior lyengar yoga instructor and 2 assistants who are licensed instructors.

How (delivery) - Group-based

When, how much (dosage) - 6 (12 classes) or 12 (22 classes) wks, 90 min/session.

Tailoring - postures were based on recommendations from Geeta lyengar and adapted based on individual needs.

Swenson

2014

Effectiveness

n = 75

Appropriateness

Intervention

Community (specialist exercise clinic)

Any cancer type

What (materials) - treadmills, elliptical machines, upright and recumbent bikes, a Life-Fitness functional cable machine, and a walking track

Who (qualifications) – Physiotherapist

How (delivery) Individual assessment determined whether participants participated in individual or group sessions (maximum 4 participant)

When, how much (dosage) - 8-wk program with option of 6 months maintenance. Combined aerobic exercise and strength training. Individual sessions 60 min duration. Group sessions 90 min

Tailoring - Session intensity and duration were adjusted for participants according to individual physiological measures

VanGerpen

2013

Effectiveness/

Implementation

n = 121

Appropriateness

Intervention

Community (specialist exercise clinic)

Any cancer type

What (materials) - resistance band for home use. Stationary bike, treadmill, indoor walking track, recumbent stepper, upper body ergometer. Dumbbell, machines, resistance band.

Who (qualifications) - Physiotherapist or exercise physiologist

How (delivery) - Group-based (max. 12 participants per group) When, how much (dosage) - 12-wk program. 30 min aerobic exercise (5-min intervals on equipment), 30 min of either strength (rotating through equipment described above), flexibly, Pilates, yoga, relaxation or water-based exercise. Patient monitored intensity

Tailoring - Not reported

Wurz

2013

Implementation

NA

Adoption

Organisation

Community (specialist exercise clinic)

Any cancer type

What (materials) – Not reported

Who (qualifications) - qualified yoga instructors

How(delivery)- group-based in the community

When, how much (dosage) - 7 wk. program (1x75minute session). Combine initial breathing exercises, then 6–10 modified yoga poses, finish with relaxation exercise.

Tailoring - Individualized