Reaching Remote Cancer Survivors

Dr Nicole Culos-Reed believes that movement is medicine. The professor in the faculty of kinesiology at the University of Calgary wants to see an evidence-based exercise program as part of standard cancer care. She explains exercise can reduce the negative side-effects of cancer treatment, like cancer-related fatigue and muscle weakness, and can also improve other patient-reported outcomes.

That was the motivation behind the Alberta Cancer Exercise (ACE) program that Culos-Reed co-leads. Launched in 2017, ACE is a five-year study and free 12-week community exercise program for both cancer survivors and people currently in treatment. But Culos-Reed knows ACE isn’t reaching all survivors. Many are unable to access this type of programming simply because of where they live.

“ACE runs across many Alberta cities — but they are still cities. We’re not getting that cancer survivor who lives in smalltown, rural Alberta,” says Culos-Reed.

So, when the Canadian Institutes of Health Research and the Canadian Cancer Society put out a call for applications for a Cancer Survivorship Team Grant, Culos- Reed contacted colleagues across the country. By working together, Culos-Reed hoped to scale up ACE and deliver exercise programs to cancer survivors living all over Canada.

The grant, which includes additional funding from the Alberta Cancer Foundation, was collectively awarded to Culos-Reed, Dr. Margaret McNeely from the University of Alberta, Dr. Melanie Keats from Dalhousie University and Dr. Daniel Santa Mina from the University of Toronto, as well as a team of clinical, research and community- based organizations, colleagues and trainees. And, in September 2020, Exercise for Cancer to Enhance Living Well, or EXCEL, launched.

“The goal with EXCEL is to make sure we can offer the same exercise oncology cancer care resources to rural cancer survivors,” says Culos-Reed, EXCEL’s lead. “It’s about improving access to physical activity because there has been a disparity in reaching people that are outside of major centres.”

EXCEL works much like ACE. After a baseline fitness assessment, participants join in group-based, hour-long circuit-style training sessions twice a week, for 12 weeks. Participants do a variety of aerobic, strength training, balance and flexibility exercises, all of which can be modified for their fitness level. The classes are led by fitness professionals, who the EXCEL team has trained to work with cancer survivors. And, as it is a study, the team collects data at the end of the program to determine whether participants’ fitness has improved and whether the program delivery is effective.

Due to the COVID-19 pandemic, all assessments and programming are delivered via Zoom — participants log-in and work out remotely. Culos-Reed hopes that delivery will expand to rural community and fitness centres when it’s safe, although EXCEL will always have an online component.

“Before launching, we knew we couldn’t have a community-based exercise program at every single site where a rural cancer survivor lived. Economically, that’s just not feasible,” says Culos-Reed. “We’d always planned for an online component, to reach more people faster.”

EXCEL was launched in rural communities in Alberta this past fall. In January, Keats, Santa Mina and their teams brought EXCEL to survivors living in remote parts of Nova Scotia, and the program is expanding into Ontario this spring. EXCEL leads are currently doing increased outreach to recruit cancer survivors living in remote areas of B.C. and Saskatchewan.

EXCEL is still in its infancy, and data collection is ongoing, but participants’ feedback already highlights its effectiveness.

“I am very grateful for the EXCEL program because, as a rural cancer survivor, I have limited access to supports,” says Judy, an Alberta-based participant. “It’s an opportunity for me to become more active while connecting with other people in a similar situation. I have come to have a stronger commitment to my own well-being as I recover because of this amazing program.”

Going forward, Culos-Reed says the team is looking into adding fitness tracking tools, like the Alberta-based digital journal ZoeInsights, funded by the Alberta Cancer Foundation. Additionally, they hope to recruit thousands of participants and also create a network of trained exercise professionals across the country.

“Our big goal is for Canadians living outside of cities to find out about EXCEL right away,” says Culos-Reed. “And that they feel very supported and have wellness opportunities throughout their cancer journey.”