A comparison between face-to-face and telehealth exercise for individuals diagnosed with cancer.

<p dir="ltr">Purpose: Cancer is a major cause of illness burden within Australia and around the globe. Exercise has been well established as a safe and effective intervention to mitigate the negative physical and psychological effects of cancer and its treatments. However, despite these benefits, individuals do not always meet the recommended exercise guidelines. One barrier to participation in exercise is accessibility to exercise programs. Virtual exercise programs may be a viable solution which could enhance accessibility, increase participation rates and potentially improve patient outcomes. The primary aim of the work presented in this thesis is to explore virtual exercise delivery modes and their effects on physical and quality of life outcomes for individuals with a cancer diagnosis. This was accomplished through the completion of a systematic review and a pilot study.</p><p dir="ltr">Systematic Review: A systematic review of studies from the past five years, in the covid-19 and post covid-19 period, was completed comparing virtually delivered exercise programs for individuals with a cancer diagnosis to traditional models of care. The aim was to assess whether similar physical and quality of life outcomes could be achieved. The literature review demonstrated that virtual exercise programs could improve quality of life outcomes and enhance physical function, yielding outcomes comparable to face-to-face delivery for most groups. However, evidence suggests that certain subgroups may benefit more from in person training, indicating the necessity of a tailored approach to exercise prescription in cancer care. Despite these promising findings, further research is required to differentiate the effects of the exercise delivery mode from the effects of the specific components of the exercise interventions. Future studies should employ study designs to directly compare virtual and face-to-face outcomes. Understanding these dynamics is essential for optimising exercise interventions and ensuring all individuals with a cancer diagnosis receive the most effective and accessible care.</p><p dir="ltr">Pilot Study: A pilot study was conducted to examine the impact of different exercise delivery modes, specifically: face-to-face and telehealth, for individuals with a cancer diagnosis with the aim to assess the physical and quality of life outcomes after completing a 12-session exercise program. While previous research has explored physical and quality of life outcomes across various face-to-face and virtual platforms, few studies have compared equivalent interventions across these settings. This study aimed to directly compare face-to-face and telehealth delivery modes using a consistent exercise program and consistent pre and post assessment protocols. The findings revealed that the 12-session supervised exercise intervention resulted in improvements in physical performance outcomes, particularly in the one-minute sit to stand test (STS) for both groups and the six-minute walk test (6MWT) distance for the telehealth group. The face-to-face group exhibited statistically significant improvements in fatigue measured by the Brief Fatigue Inventory (BFI), while the telehealth group displayed statistically significant improvements in quality of life, as measured by the EORTC Core Quality of Life questionnaire (EORTC-QLQ-C30).</p><p dir="ltr">Implications: The physical and quality of life impacts of cancer significantly increase the disease burden, intensifying both physical and psychological challenges for affected individuals. Evidence suggests that exercise plays a critical role in mitigating the adverse side effects of cancer and its treatments, including fatigue, loss of functional capacity, and diminished overall well-being and quality of life. Therefore, advancing our understanding of the most effective exercise delivery modes and their associated outcomes is crucial in increasing exercise participation and reducing disease burden. Enhanced knowledge in this area is vital for expanding access to supervised exercise therapy, particularly for those who may face barriers to traditional face-to-face programs, such as geographic, financial, or health-related constraints. By offering varying effective supervised exercise delivery methods, we can potentially improve adherence to exercise therapy for a large population, which is essential for achieving sustained physical and psychological benefits. Furthermore, increased accessibility and adherence could lead to broader adoption of exercise interventions within oncology care, ultimately contributing to better patient outcomes and a reduction in the overall burden of cancer.</p>